Provider Demographics
NPI:1336606318
Name:LONOKE SMILE CENTER PLLC
Entity Type:Organization
Organization Name:LONOKE SMILE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MATONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-337-3978
Mailing Address - Street 1:123 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LONOKE
Mailing Address - State:AR
Mailing Address - Zip Code:72086-2805
Mailing Address - Country:US
Mailing Address - Phone:501-676-6770
Mailing Address - Fax:
Practice Address - Street 1:123 N CENTER ST
Practice Address - Street 2:
Practice Address - City:LONOKE
Practice Address - State:AR
Practice Address - Zip Code:72086-2805
Practice Address - Country:US
Practice Address - Phone:501-676-6770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty