Provider Demographics
NPI:1295730562
Name:ATKINSON, D. ROSS (DDS)
Entity type:Individual
Prefix:
First Name:D.
Middle Name:ROSS
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 MALVERN AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-8176
Mailing Address - Country:US
Mailing Address - Phone:501-262-4010
Mailing Address - Fax:501-262-5933
Practice Address - Street 1:2633 MALVERN AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8176
Practice Address - Country:US
Practice Address - Phone:501-262-4010
Practice Address - Fax:501-262-5933
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR161223P0300X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58488Medicare ID - Type UnspecifiedBC/BS INS IDENTIFIER