Healthcare Provider Details

I. General information

NPI: 1023136462
Provider Name (Legal Business Name): SAMUEL M STRONG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 BRECKENRIDGE DR STE D
LITTLE ROCK AR
72227
US

IV. Provider business mailing address

1415 BRECKENRIDGE DR STE D
LITTLE ROCK AR
72227
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-2333
  • Fax: 501-224-5230
Mailing address:
  • Phone: 501-224-2333
  • Fax: 501-224-5230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2137
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: