Provider Demographics
NPI:1700914173
Name:ARKANSAS DENTAL ASSOCIATES, P.L.L.C.
Entity Type:Organization
Organization Name:ARKANSAS DENTAL ASSOCIATES, P.L.L.C.
Other - Org Name:FAMILY DENTISTRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:R
Authorized Official - Last Name:NANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-524-9379
Mailing Address - Street 1:3860 HIGHWAY 412 E STE F
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-8510
Mailing Address - Country:US
Mailing Address - Phone:479-524-9379
Mailing Address - Fax:479-524-0976
Practice Address - Street 1:3860 HIGHWAY 412 E
Practice Address - Street 2:SUITE F
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-8510
Practice Address - Country:US
Practice Address - Phone:479-524-9379
Practice Address - Fax:479-524-0976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR33691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty