Provider Demographics
NPI:1811008378
Name:ANTHONY L. TORTORICH, DDS, PA
Entity Type:Organization
Organization Name:ANTHONY L. TORTORICH, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:L
Authorized Official - Last Name:TORTORICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-224-8332
Mailing Address - Street 1:4220 N RODNEY PARHAM RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-2453
Mailing Address - Country:US
Mailing Address - Phone:501-224-8332
Mailing Address - Fax:501-219-8003
Practice Address - Street 1:4220 N RODNEY PARHAM RD
Practice Address - Street 2:SUITE 103
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-2453
Practice Address - Country:US
Practice Address - Phone:501-224-8332
Practice Address - Fax:501-219-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR27211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ART20586Medicare UPIN