Provider Demographics
NPI:1972038628
Name:MICHAEL ASHCRAFT D.D.S., M.S., P.A.
Entity Type:Organization
Organization Name:MICHAEL ASHCRAFT D.D.S., M.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREATMENT & FINANCIAL COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLAKOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-225-3964
Mailing Address - Street 1:23 SHACKLEFORD DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2859
Mailing Address - Country:US
Mailing Address - Phone:501-225-3964
Mailing Address - Fax:501-225-8964
Practice Address - Street 1:23 SHACKLEFORD DR
Practice Address - Street 2:SUITE A
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-2859
Practice Address - Country:US
Practice Address - Phone:501-225-3964
Practice Address - Fax:501-225-8964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR28381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR207606631Medicaid
AR117909608Medicaid