Healthcare Provider Details

I. General information

NPI: 1700346772
Provider Name (Legal Business Name): ASHCRAFT ORTHODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 SHACKLEFORD DR STE A
LITTLE ROCK AR
72211-2990
US

IV. Provider business mailing address

23 SHACKLEFORD DR STE A
LITTLE ROCK AR
72211-2990
US

V. Phone/Fax

Practice location:
  • Phone: 501-225-3964
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: MIKE COLE
Title or Position: VP INSURANCE PLAN MANAGEMENT
Credential:
Phone: 941-955-3150