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General NPI Number Information
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NPI Number | 1972714798
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Entity Type | Organization
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Legal Business Name | LANDMARK DENTAL CENTER
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 09/10/2009
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Provider Practice Location Address
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Address Line | 3401 ATWOOD RD SUITE D
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City | LITTLE ROCK
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State | AR
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Zip | 72206-6012
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Country | US
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Telephone | 501-888-1197
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Fax |
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Provider Business Mailing Address
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Address Line | 3401 ATWOOD RD SUITE D
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City | LITTLE ROCK
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State | AR
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Zip | 72206-6012
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Country | US
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Telephone | 501-888-1197
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. TARA PAPPAS SCALLION
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Credential | DDS
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Telephone | 501-888-1197
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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 | 3189
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License Number State | AR
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