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General NPI Number Information
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NPI Number | 1699104109
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Entity Type | Organization
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Legal Business Name | TRI LAKES DENTISTRY, PLLC
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 11/05/2013
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Provider Practice Location Address
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Address Line | 2840 MALVERN AVE
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City | HOT SPRINGS
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State | AR
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Zip | 71901-8320
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Country | US
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Telephone | 501-262-3100
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Fax | 501-881-4259
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Provider Business Mailing Address
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Address Line | 2840 MALVERN AVE
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City | HOT SPRINGS
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State | AR
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Zip | 71901-8320
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Country | US
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Telephone | 501-262-3100
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Fax | 501-881-4259
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Authorized Official
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Title or Position | DENTIST
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Name | DR. NEAL ADAM DELEE
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Credential | D.D.S.
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Telephone | 501-262-3100
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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 | 3581
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License Number State | AR
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