Healthcare Provider Details

I. General information

NPI: 1366458044
Provider Name (Legal Business Name): DINESH MITTAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 FORT ROOTS DR BUILDING 58 (152/NLR)
NORTH LITTLE ROCK AR
72114-1709
US

IV. Provider business mailing address

2200 FORT ROOTS DR BUILDING 58 (152/NLR)
NORTH LITTLE ROCK AR
72114-1709
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-1234
  • Fax: 501-257-1749
Mailing address:
  • Phone: 501-257-1234
  • Fax: 501-257-1749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number12984
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: