Provider Demographics
NPI:1942074224
Name:ALL STAR SMILES
Entity Type:Organization
Organization Name:ALL STAR SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-747-1004
Mailing Address - Street 1:11312 BASS PRO PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-3086
Mailing Address - Country:US
Mailing Address - Phone:501-747-1004
Mailing Address - Fax:501-421-9070
Practice Address - Street 1:11312 BASS PRO PKWY STE C
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-3086
Practice Address - Country:US
Practice Address - Phone:501-747-1004
Practice Address - Fax:501-421-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty