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General NPI Number Information
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NPI Number | 1669146239
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Entity Type | Organization
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Legal Business Name | HERMITAGE DENTISTRY GPS PLLC
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Dates
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Enumeration Date | 08/05/2021
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 260 JACKSON MEADOWS DR # 1425
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City | HERMITAGE
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State | TN
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Zip | 37076-1425
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Country | US
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Telephone | 615-872-7762
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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 REYNOLDS 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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