Provider Demographics
NPI:1669482063
Name:ASHCRAFT, MICHAEL B (DDS, MS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:ASHCRAFT
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:B
Other - Last Name:ASHCRAFT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS,MS,PA
Mailing Address - Street 1:23 SHACKLEFORD DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2859
Mailing Address - Country:US
Mailing Address - Phone:501-225-3964
Mailing Address - Fax:501-225-8964
Practice Address - Street 1:23 SHACKLEFORD DR
Practice Address - Street 2:SUITE A
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-2859
Practice Address - Country:US
Practice Address - Phone:501-225-3964
Practice Address - Fax:501-225-8964
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR28381223X0400X
AR7211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1972038628Medicaid
AR117909608Medicaid
AR710694372OtherTIN
AR1972038628Medicaid
AR117909608Medicaid