Provider Demographics
NPI:1770796401
Name:RANDALL S HESTIR DDS INC
Entity type:Organization
Organization Name:RANDALL S HESTIR DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:S
Authorized Official - Last Name:HESTIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-946-2013
Mailing Address - Street 1:PO DRAWER 512
Mailing Address - Street 2:1703 S WHITEHEAD DR
Mailing Address - City:DEWITT
Mailing Address - State:AR
Mailing Address - Zip Code:72042
Mailing Address - Country:US
Mailing Address - Phone:870-946-2013
Mailing Address - Fax:870-946-1281
Practice Address - Street 1:1703 S WHITEHEAD DR
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:AR
Practice Address - Zip Code:72042
Practice Address - Country:US
Practice Address - Phone:870-946-2013
Practice Address - Fax:870-946-1281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO22661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100922608Medicaid