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General NPI Number Information
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NPI Number | 1386268696
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Entity Type | Organization
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Legal Business Name | MAIN STREET DENTAL GPS, PLLC
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Dates
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Enumeration Date | 06/02/2020
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Last Update Date | 06/02/2020
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Provider Practice Location Address
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Address Line | 312 S MAIN ST
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City | BENTONVILLE
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State | AR
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Zip | 72712-5903
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Country | US
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Telephone | 479-254-6899
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Fax |
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Provider Business Mailing Address
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Address Line | 100 E HUNTINGTON AVE STE E
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City | JONESBORO
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State | AR
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Zip | 72401-2900
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Country | US
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Telephone | 870-243-4406
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. WILLIAM R LITTLE
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Credential | DDS
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Telephone | 870-243-4406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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