Provider Demographics
NPI:1770932550
Name:SILLS DERMATOLOGY, PLLC
Entity type:Organization
Organization Name:SILLS DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:SILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-336-1600
Mailing Address - Street 1:PO BOX 16788
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-6712
Mailing Address - Country:US
Mailing Address - Phone:870-336-1600
Mailing Address - Fax:870-336-0585
Practice Address - Street 1:1003 WINDOVER RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6007
Practice Address - Country:US
Practice Address - Phone:870-336-1600
Practice Address - Fax:870-336-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-12
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4809207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty