Healthcare Provider Details

I. General information

NPI: 1700094786
Provider Name (Legal Business Name): HEATHMAN FAMILY DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12501 CANTRELL RD
LITTLE ROCK AR
72223-1639
US

IV. Provider business mailing address

12501 CANTRELL RD
LITTLE ROCK AR
72223-1639
US

V. Phone/Fax

Practice location:
  • Phone: 501-223-3838
  • Fax: 501-223-2554
Mailing address:
  • Phone: 501-223-3838
  • Fax: 501-223-2554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TANK PAM
Title or Position: OFFICE MANAGER
Credential:
Phone: 501-223-3838