Healthcare Provider Details

I. General information

NPI: 1811008378
Provider Name (Legal Business Name): ANTHONY L. TORTORICH, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 N RODNEY PARHAM RD SUITE 103
LITTLE ROCK AR
72212-2453
US

IV. Provider business mailing address

4220 N RODNEY PARHAM RD SUITE 103
LITTLE ROCK AR
72212-2453
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-8332
  • Fax: 501-219-8003
Mailing address:
  • Phone: 501-224-8332
  • Fax: 501-219-8003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2721
License Number StateAR

VIII. Authorized Official

Name: DR. ANTHONY L. TORTORICH
Title or Position: ORAL AND MAXILLOFACIAL SURGEON
Credential: D.D.S.
Phone: 501-224-8332