Provider Demographics
NPI:1942352596
Name:MCCALL, TOMIE JR
Entity Type:Individual
Prefix:DR
First Name:TOMIE
Middle Name:
Last Name:MCCALL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 966
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206
Mailing Address - Country:US
Mailing Address - Phone:501-374-2525
Mailing Address - Fax:
Practice Address - Street 1:721 EAST 21ST STREET
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206
Practice Address - Country:US
Practice Address - Phone:501-374-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2509122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
478180OtherUNITED CONCORDIA
58745OtherAR BLUECROSS BLUESHIELD