Provider Demographics
NPI:1457426991
Name:MACHEN, BILLY RANDALL (DDS PA)
Entity Type:Individual
Prefix:DR
First Name:BILLY
Middle Name:RANDALL
Last Name:MACHEN
Suffix:
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 N RODNEY PARHAM RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-2453
Mailing Address - Country:US
Mailing Address - Phone:501-954-9900
Mailing Address - Fax:501-661-0066
Practice Address - Street 1:4220 N RODNEY PARHAM RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-2453
Practice Address - Country:US
Practice Address - Phone:501-954-9900
Practice Address - Fax:501-661-0066
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARDAR2779122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist