Healthcare Provider Details

I. General information

NPI: 1003554973
Provider Name (Legal Business Name): ALEX ABBOTT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2022
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST # 624
LITTLE ROCK AR
72205-7199
US

IV. Provider business mailing address

3012 N HILLS BLVD APT 4217
NORTH LITTLE ROCK AR
72116-9446
US

V. Phone/Fax

Practice location:
  • Phone: 501-526-7619
  • Fax:
Mailing address:
  • Phone: 501-520-1472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4615
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: