Provider Demographics
NPI:1972714798
Name:LANDMARK DENTAL CENTER
Entity Type:Organization
Organization Name:LANDMARK DENTAL CENTER
Other - Org Name:TARA PAPPAS SCALLION DDS PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:PAPPAS
Authorized Official - Last Name:SCALLION
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-888-1197
Mailing Address - Street 1:3401 ATWOOD RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-6012
Mailing Address - Country:US
Mailing Address - Phone:501-888-1197
Mailing Address - Fax:
Practice Address - Street 1:3401 ATWOOD RD
Practice Address - Street 2:SUITE D
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-6012
Practice Address - Country:US
Practice Address - Phone:501-888-1197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3189261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR159516631Medicaid