Provider Demographics
NPI:1912318031
Name:D. ROSS ATKINSON SPECIALTY DENTAL SERVICES
Entity Type:Organization
Organization Name:D. ROSS ATKINSON SPECIALTY DENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS STAFF
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:JO
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-262-4010
Mailing Address - Street 1:2633 MALVERN AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-8176
Mailing Address - Country:US
Mailing Address - Phone:501-262-4010
Mailing Address - Fax:501-262-5933
Practice Address - Street 1:2633 MALVERN AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8176
Practice Address - Country:US
Practice Address - Phone:501-262-4010
Practice Address - Fax:501-262-5933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty