Healthcare Provider Details

I. General information

NPI: 1235538778
Provider Name (Legal Business Name): KARLA K. GAINES, D.D.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 N DIXIELAND RD
ROGERS AR
72756-3205
US

IV. Provider business mailing address

802 N DIXIELAND RD
ROGERS AR
72756-3205
US

V. Phone/Fax

Practice location:
  • Phone: 479-936-8800
  • Fax: 479-936-8808
Mailing address:
  • Phone: 479-936-8800
  • Fax: 479-936-8808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3098
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number3098
License Number StateAR

VIII. Authorized Official

Name: DR. KARLA KAY GAINES
Title or Position: DENTIST
Credential: DDS
Phone: 479-936-8800