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General NPI Number Information
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NPI Number | 1639771827
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Entity Type | Organization
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Legal Business Name | ERIC K. MATHIS, DDS
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Dates
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Enumeration Date | 11/12/2020
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 26 GREEN VALLEY DR
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653-8102
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Country | US
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Telephone | 870-425-6911
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Fax | 870-425-0699
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Provider Business Mailing Address
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Address Line | 26 GREEN VALLEY DR
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653-8102
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Country | US
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Telephone | 870-425-6911
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Fax | 870-425-0699
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | PAM K FLOCK
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Credential |
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Telephone | 870-425-6911
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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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