Provider Demographics
NPI:1912638354
Name:VILLAGE DENTAL CENTER, PLLC
Entity Type:Organization
Organization Name:VILLAGE DENTAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:D
Authorized Official - Last Name:MATONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-490-1293
Mailing Address - Street 1:PO BOX 241785
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-0014
Mailing Address - Country:US
Mailing Address - Phone:501-520-9854
Mailing Address - Fax:
Practice Address - Street 1:1396 DESOTO BLVD
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909-7633
Practice Address - Country:US
Practice Address - Phone:501-922-1045
Practice Address - Fax:501-922-6217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty