Healthcare Provider Details

I. General information

NPI: 1285710103
Provider Name (Legal Business Name): NICK W DOLLAR DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 WEST MAIN
PARIS AR
72855
US

IV. Provider business mailing address

15 WEST MAIN
PARIS AR
72855
US

V. Phone/Fax

Practice location:
  • Phone: 479-963-3086
  • Fax: 479-963-2502
Mailing address:
  • Phone: 479-963-3086
  • Fax: 479-963-2502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3560
License Number StateAR

VIII. Authorized Official

Name: DR. NICK W DOLLAR
Title or Position: OWNER
Credential: DDS
Phone: 479-963-3086