Healthcare Provider Details

I. General information

NPI: 1215375407
Provider Name (Legal Business Name): ENDODONTIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 BRECKENRIDGE DR STE 203
LITTLE ROCK AR
72205-1558
US

IV. Provider business mailing address

1225 BRECKENRIDGE DR STE 203
LITTLE ROCK AR
72205-1558
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-7949
  • Fax: 501-227-7763
Mailing address:
  • Phone: 501-227-7949
  • Fax: 501-227-7763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number3100
License Number StateAR

VIII. Authorized Official

Name: DR. AMIR MEHRABI
Title or Position: D.D.S., M.S.D.
Credential:
Phone: 501-227-7949