Provider Demographics
NPI:1841461274
Name:ARKANSAS ORAL SURGERY
Entity type:Organization
Organization Name:ARKANSAS ORAL SURGERY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:QUICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-329-3223
Mailing Address - Street 1:2425 PRINCE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3746
Mailing Address - Country:US
Mailing Address - Phone:501-329-3223
Mailing Address - Fax:501-329-8939
Practice Address - Street 1:2425 PRINCE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3746
Practice Address - Country:US
Practice Address - Phone:501-329-3223
Practice Address - Fax:501-329-8939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR65261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1841461274OtherNPI GROUP
AR165772679Medicaid
1346203395OtherNPI INDIVIDUAL
AR165774680Medicaid
AR1841461274OtherNPI GROUP