Healthcare Provider Details

I. General information

NPI: 1831626183
Provider Name (Legal Business Name): D&D DOCTORS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 07/09/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20602 ARCH STREET PIKE
HENSLEY AR
72065-9442
US

IV. Provider business mailing address

20602 ARCH STREET PIKE
HENSLEY AR
72065-9442
US

V. Phone/Fax

Practice location:
  • Phone: 347-851-0116
  • Fax: 501-891-5672
Mailing address:
  • Phone: 347-851-0116
  • Fax: 501-891-5672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE4008
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberE4008
License Number StateAR

VIII. Authorized Official

Name: SANJAY R DASS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 501-626-0053