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General NPI Number Information
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NPI Number | 1639690811
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Entity Type | Organization
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Legal Business Name | DDS MEDICAL, PLLC
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 06/29/2017
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Provider Practice Location Address
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Address Line | 2 SAINT VINCENT CIR
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5423
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Country | US
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Telephone | 501-626-0053
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Fax |
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Provider Business Mailing Address
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Address Line | 12780 RIVERCREST DR
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City | LITTLE ROCK
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State | AR
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Zip | 72212-1444
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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 | OWNER
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Name | SANJAY DASS
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Credential | MD
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Telephone | 501-626-0053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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