Healthcare Provider Details

I. General information

NPI: 1639690811
Provider Name (Legal Business Name): DDS MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 06/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SAINT VINCENT CIR
LITTLE ROCK AR
72205-5423
US

IV. Provider business mailing address

12780 RIVERCREST DR
LITTLE ROCK AR
72212-1444
US

V. Phone/Fax

Practice location:
  • Phone: 501-626-0053
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SANJAY DASS
Title or Position: OWNER
Credential: MD
Phone: 501-626-0053