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General NPI Number Information
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NPI Number | 1700094786
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Entity Type | Organization
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Legal Business Name | HEATHMAN FAMILY DENTAL INC
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 08/19/2020
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Provider Practice Location Address
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Address Line | 12501 CANTRELL RD
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City | LITTLE ROCK
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State | AR
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Zip | 72223-1639
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Country | US
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Telephone | 501-223-3838
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Fax | 501-223-2554
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Provider Business Mailing Address
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Address Line | 12501 CANTRELL RD
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City | LITTLE ROCK
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State | AR
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Zip | 72223-1639
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Country | US
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Telephone | 501-223-3838
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Fax | 501-223-2554
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. TANK PAM
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Credential |
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Telephone | 501-223-3838
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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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