Healthcare Provider Details

I. General information

NPI: 1033346143
Provider Name (Legal Business Name): VONDRAN ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 06/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 N RODNEY PARHAM RD STE 310
LITTLE ROCK AR
72212-2466
US

IV. Provider business mailing address

4220 N RODNEY PARHAM RD STE 310
LITTLE ROCK AR
72212-2466
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-3421
  • Fax: 501-224-1305
Mailing address:
  • Phone: 501-224-3421
  • Fax: 501-224-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES A. VONDRAN JR.
Title or Position: DOCTOR
Credential: D.D.S.M.D.S.
Phone: 501-224-3421