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General NPI Number Information
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NPI Number | 1124491733
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Entity Type | Organization
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Legal Business Name | ORAL SURGERY OF CENTRAL ARKANSAS
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Dates
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Enumeration Date | 11/04/2015
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Last Update Date | 11/04/2015
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Provider Practice Location Address
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Address Line | 2504 MCCAIN BLVD STE 202
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72116-7612
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Country | US
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Telephone | 501-771-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 2504 MCCAIN BLVD STE 202
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72116-7612
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN M JOHNSON
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Credential | DDS
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Telephone | 501-327-5255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 2606
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 3775
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License Number State | AR
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