Provider Demographics
NPI:1821399445
Name:TRIDENT HOLDING LLC
Entity Type:Organization
Organization Name:TRIDENT HOLDING LLC
Other - Org Name:HOTSPRINGS DENTAL LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:BURRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:501-321-2211
Mailing Address - Street 1:1702 MALVERN AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-7132
Mailing Address - Country:US
Mailing Address - Phone:501-321-2211
Mailing Address - Fax:501-321-0551
Practice Address - Street 1:1702 MALVERN AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7132
Practice Address - Country:US
Practice Address - Phone:501-321-2211
Practice Address - Fax:501-321-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty