Healthcare Provider Details

I. General information

NPI: 1174816706
Provider Name (Legal Business Name): C. ED KNIGHT, D.D.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 LILE DR STE 240
LITTLE ROCK AR
72205-6342
US

IV. Provider business mailing address

9601 LILE DR STE 240
LITTLE ROCK AR
72205-6342
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-3008
  • Fax: 501-224-3009
Mailing address:
  • Phone: 501-224-3008
  • Fax: 501-224-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2163
License Number StateAR

VIII. Authorized Official

Name: CHARLES EDWIN KNIGHT
Title or Position: OWNER
Credential: D.D.S.
Phone: 501-224-3008