Provider Demographics
NPI:1396958880
Name:REGIONAL DENTAL CENTER INC
Entity type:Organization
Organization Name:REGIONAL DENTAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:UDOUJ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:479-782-3005
Mailing Address - Street 1:520 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-4608
Mailing Address - Country:US
Mailing Address - Phone:479-782-3005
Mailing Address - Fax:479-494-7490
Practice Address - Street 1:520 S 14TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4608
Practice Address - Country:US
Practice Address - Phone:479-782-3005
Practice Address - Fax:479-494-7490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR27251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty