Healthcare Provider Details

I. General information

NPI: 1588803555
Provider Name (Legal Business Name): HSRC DENTAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 02/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 RESERVE ST
HOT SPRINGS AR
71901-4195
US

IV. Provider business mailing address

105 RESERVE ST
HOT SPRINGS AR
71901-4195
US

V. Phone/Fax

Practice location:
  • Phone: 501-701-6217
  • Fax: 501-624-0019
Mailing address:
  • Phone: 501-701-6217
  • Fax: 501-624-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1881
License Number StateAR

VIII. Authorized Official

Name: MS. BARBARA LEWIS
Title or Position: HOSPITAL ADMINISTRATOR
Credential:
Phone: 501-701-6310