Provider Demographics
NPI:1891987061
Name:MIRANDA M CHILDS DDS
Entity Type:Organization
Organization Name:MIRANDA M CHILDS DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:CHILDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-245-2323
Mailing Address - Street 1:312 PROFESSIONAL PARK DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-5315
Mailing Address - Country:US
Mailing Address - Phone:870-245-2323
Mailing Address - Fax:870-245-2368
Practice Address - Street 1:312 PROFESSIONAL PARK DR
Practice Address - Street 2:SUITE D
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-5315
Practice Address - Country:US
Practice Address - Phone:870-245-2323
Practice Address - Fax:870-245-2368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3103122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR766360OtherUNITED CONCORDIA
AR5U242OtherBLUE CROSS