Provider Demographics
NPI:1851592919
Name:C. M. RISK, D.D.S.
Entity Type:Organization
Organization Name:C. M. RISK, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:C.
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RISK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-425-4777
Mailing Address - Street 1:400 S COLLEGE ST
Mailing Address - Street 2:SUITE #4
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3923
Mailing Address - Country:US
Mailing Address - Phone:870-425-4777
Mailing Address - Fax:870-425-6345
Practice Address - Street 1:400 S COLLEGE ST
Practice Address - Street 2:SUITE #4
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3923
Practice Address - Country:US
Practice Address - Phone:870-425-4777
Practice Address - Fax:870-425-6345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR23051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty