Healthcare Provider Details

I. General information

NPI: 1396036018
Provider Name (Legal Business Name): ALL SMILES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 HARRISON ST
BATESVILLE AR
72501-7513
US

IV. Provider business mailing address

2940 HARRISON ST
BATESVILLE AR
72501-7513
US

V. Phone/Fax

Practice location:
  • Phone: 870-569-4920
  • Fax:
Mailing address:
  • Phone: 870-569-4920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number3708
License Number StateAR

VIII. Authorized Official

Name: STACEY HANEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 870-569-4920