Healthcare Provider Details

I. General information

NPI: 1437601788
Provider Name (Legal Business Name): APEX DENTAL PARTNERS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 CENTERVIEW DR SUITE 114
LITTLE ROCK AR
72211-4308
US

IV. Provider business mailing address

1701 CENTERVIEW DR SUITE 114
LITTLE ROCK AR
72211-4308
US

V. Phone/Fax

Practice location:
  • Phone: 501-328-5439
  • Fax: 501-328-5011
Mailing address:
  • Phone: 501-328-5439
  • Fax: 501-328-5011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateAR

VIII. Authorized Official

Name: EDITH I PEREZ
Title or Position: OFFICE COORDINATOR
Credential:
Phone: 501-328-5439