Healthcare Provider Details

I. General information

NPI: 1346962586
Provider Name (Legal Business Name): PDG DENTAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 FAIRWAY AVE
NORTH LITTLE ROCK AR
72116
US

IV. Provider business mailing address

4605 FAIRWAY AVE
NORTH LITTLE ROCK AR
72116
US

V. Phone/Fax

Practice location:
  • Phone: 501-771-2990
  • Fax: 501-753-0408
Mailing address:
  • Phone: 501-771-2990
  • Fax: 501-753-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHANIE G MEEK
Title or Position: OWNER
Credential: DDS
Phone: 501-771-2990