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General NPI Number Information
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NPI Number | 1194226506
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Entity Type | Organization
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Legal Business Name | GKLM, PLLC
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Dates
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Enumeration Date | 02/22/2018
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 1874 N HUNTERS RDG STE 1
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-2896
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Country | US
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Telephone | 479-442-5092
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Fax | 479-587-0932
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Provider Business Mailing Address
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Address Line | 1874 N HUNTERS RDG STE 1
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-2896
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Country | US
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Telephone | 479-442-5092
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Fax | 479-587-0932
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Authorized Official
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Title or Position | DENTIST
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Name | DR. GRANT ALAN DAVIDSON
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Credential | DDS
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Telephone | 479-442-5092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2439
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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