Healthcare Provider Details

I. General information

NPI: 1518418656
Provider Name (Legal Business Name): DOUGLAS A CARMICAL DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1198 FOREST HILLS BLVD STE 107
BELLA VISTA AR
72715-2391
US

IV. Provider business mailing address

1198 FOREST HILLS BLVD STE 107
BELLA VISTA AR
72715-2391
US

V. Phone/Fax

Practice location:
  • Phone: 479-855-3313
  • Fax: 479-855-4314
Mailing address:
  • Phone: 479-855-3313
  • Fax: 479-855-4314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS A CARMICAL
Title or Position: OWNER/PROVIDER
Credential: D.D.S.
Phone: 479-855-3313