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General NPI Number Information
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NPI Number | 1679632871
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Entity Type | Organization
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Legal Business Name | SALINE DENTAL GROUP
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3001 HORIZON AVE
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City | BRYANT
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State | AR
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Zip | 72022-9162
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Country | US
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Telephone | 501-847-1022
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Fax | 501-847-5852
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Provider Business Mailing Address
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Address Line | 3001 HORIZON AVE
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City | BRYANT
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State | AR
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Zip | 72022-9162
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Country | US
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Telephone | 501-847-1022
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Fax | 501-847-5852
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Authorized Official
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Title or Position | OWNER
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Name | MR. RICHARD A CAIN
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Credential | D.D.S.
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Telephone | 501-847-1022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2382
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2979
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License Number State | AR
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