Healthcare Provider Details

I. General information

NPI: 1124396635
Provider Name (Legal Business Name): GROUNDS & MEGGERS FAMILY DENTISTRY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 CAMP ROBINSON RD SUITE B
NORTH LITTLE ROCK AR
72118-3632
US

IV. Provider business mailing address

4720 CAMP ROBINSON ROAD SUITE B
NORTH LITTLE ROCK AR
72118
US

V. Phone/Fax

Practice location:
  • Phone: 501-753-5564
  • Fax: 501-753-8650
Mailing address:
  • Phone: 501-753-5564
  • Fax: 501-753-8650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2208
License Number StateAR

VIII. Authorized Official

Name: DR. MICHAEL D GROUNDS
Title or Position: DENTIST
Credential: DDS
Phone: 501-753-5564