Healthcare Provider Details

I. General information

NPI: 1902105984
Provider Name (Legal Business Name): SENIOR DENTAL CARE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 RAHLING CIR STE C
LITTLE ROCK AR
72223-9194
US

IV. Provider business mailing address

25 RAHLING CIR STE C
LITTLE ROCK AR
72223-9194
US

V. Phone/Fax

Practice location:
  • Phone: 501-821-2214
  • Fax: 150-182-1224
Mailing address:
  • Phone: 150-182-1221
  • Fax: 150-182-1224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number2534
License Number StateAR

VIII. Authorized Official

Name: DR. CHAD MATONE
Title or Position: DOCTOR
Credential: D.D.S.
Phone: 15018212214