Healthcare Provider Details

I. General information

NPI: 1689535197
Provider Name (Legal Business Name): MRS. SOR VIVIANA HARRISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 CHAMBERY DR
MAUMELLE AR
72113-7651
US

IV. Provider business mailing address

108 CHAMBERY DR
MAUMELLE AR
72113-7651
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number14172
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: