Provider Demographics
NPI:1942620810
Name:DENTAL HEALTH ASSOCIATES OF ARKANSAS, P.A.
Entity Type:Organization
Organization Name:DENTAL HEALTH ASSOCIATES OF ARKANSAS, P.A.
Other - Org Name:SUNSET AVENUE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-8312
Mailing Address - Street 1:3617 W SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-4955
Mailing Address - Country:US
Mailing Address - Phone:479-419-9991
Mailing Address - Fax:479-365-2798
Practice Address - Street 1:3617 W SUNSET AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-4955
Practice Address - Country:US
Practice Address - Phone:479-419-9991
Practice Address - Fax:479-365-2798
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL HEALTH ASSOCIATES OF ARKANSAS, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-18
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty