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General NPI Number Information
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NPI Number | 1780095646
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Entity Type | Organization
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Legal Business Name | DALLAS STREET DENTAL
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 05/14/2014
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Provider Practice Location Address
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Address Line | 8020 DALLAS ST
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City | FORT SMITH
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State | AR
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Zip | 72903-4277
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Country | US
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Telephone | 479-452-6600
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Fax | 479-452-6692
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Provider Business Mailing Address
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Address Line | 8020 DALLAS ST
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City | FORT SMITH
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State | AR
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Zip | 72903-4277
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Country | US
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Telephone | 479-452-6600
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Fax | 479-452-6692
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Authorized Official
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Title or Position | DENTIST
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Name | DR. WILLIAM C LIGON
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Credential | D.D.S.
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Telephone | 479-452-6600
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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 | 3119
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License Number State | AR
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