Healthcare Provider Details

I. General information

NPI: 1972038628
Provider Name (Legal Business Name): MICHAEL ASHCRAFT D.D.S., M.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 SHACKLEFORD DR SUITE A
LITTLE ROCK AR
72211-2859
US

IV. Provider business mailing address

23 SHACKLEFORD DR SUITE A
LITTLE ROCK AR
72211-2859
US

V. Phone/Fax

Practice location:
  • Phone: 501-225-3964
  • Fax: 501-225-8964
Mailing address:
  • Phone: 501-225-3964
  • Fax: 501-225-8964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2838
License Number StateAR

VIII. Authorized Official

Name: MRS. AUDREY FLAKOLL
Title or Position: TREATMENT & FINANCIAL COORDINATOR
Credential:
Phone: 501-225-3964