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General NPI Number Information
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NPI Number | 1124285689
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Entity Type | Organization
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Legal Business Name | FAITH DENTAL CLINIC
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 8211 GEYER SPRINGS RD
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City | LITTLE ROCK
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State | AR
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Zip | 72209-4952
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Country | US
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Telephone | 501-562-1665
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Fax | 501-562-1667
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Provider Business Mailing Address
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Address Line | 8211 GEYER SPRINGS RD
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City | LITTLE ROCK
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State | AR
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Zip | 72209-4952
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Country | US
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Telephone | 501-562-1665
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Fax | 501-562-1667
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LILLIAM MARGARITA PRADO
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Credential | D.D.S
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Telephone | 501-562-1665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | AR
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