Healthcare Provider Details

I. General information

NPI: 1912318031
Provider Name (Legal Business Name): D. ROSS ATKINSON SPECIALTY DENTAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 MALVERN AVE
HOT SPRINGS AR
71901-8176
US

IV. Provider business mailing address

2633 MALVERN AVE
HOT SPRINGS AR
71901-8176
US

V. Phone/Fax

Practice location:
  • Phone: 501-262-4010
  • Fax: 501-262-5933
Mailing address:
  • Phone: 501-262-4010
  • Fax: 501-262-5933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number16
License Number StateAR

VIII. Authorized Official

Name: CAROL JO ATKINSON
Title or Position: BUSINESS STAFF
Credential:
Phone: 501-262-4010