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General NPI Number Information
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NPI Number | 1265828156
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Entity Type | Organization
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Legal Business Name | HD DENTAL, PA DBA SMILE DENTAL
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Dates
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Enumeration Date | 04/08/2015
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Last Update Date | 04/08/2015
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Provider Practice Location Address
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Address Line | 6009 HIGHWAY 1 SOUTH
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City | JONESBORO
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State | AR
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Zip | 72404
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Country | US
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Telephone | 870-336-5621
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Fax |
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Provider Business Mailing Address
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Address Line | 14810 CANTRELL RD
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City | LITTLE ROCK
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State | AR
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Zip | 72223
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Country | US
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Telephone | 844-463-5677
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | LAI FERRELL
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Credential |
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Telephone | 870-336-5621
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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 | 3393
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2929
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License Number State | AR
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