Healthcare Provider Details

I. General information

NPI: 1508727504
Provider Name (Legal Business Name): CAPITOL ORAL SURGERY & IMPLANT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SAINT VINCENT CIR STE 100
LITTLE ROCK AR
72205-5415
US

IV. Provider business mailing address

2307 W BEEBE CAPPS EXPY # 166
SEARCY AR
72143-4905
US

V. Phone/Fax

Practice location:
  • Phone: 501-672-9911
  • Fax: 866-578-8191
Mailing address:
  • Phone:
  • Fax: 866-578-8191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BETHANY ABBOTT
Title or Position: MANAGER
Credential:
Phone: 501-672-9911