MEDICARE: ATKINS DENTAL CLINIC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	817	AR

General Provider Information

NPI Number	:	1649381971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATKINS DENTAL CLINIC PC

Provider Business Mailing Address
First Line	:	406 N CHURCH ST
Second Line	:	P.O. BOX 406
City	:	ATKINS
State	:	AR
Zip	:	72823-4149
Country	:	US
Telephone Number	:	479-641-1081
Fax Number	:	479-641-7705

Provider Business Practice Location Address
First Line	:	406 N CHURCH ST
Second Line	:
City	:	ATKINS
State	:	AR
Zip	:	72823-4149
Country	:	US
Telephone Number	:	479-641-1081
Fax Number	:	479-641-7705

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROY L. BRATTON
Credential	:	DDS
Telephone Number	:	479-641-1081

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/22/2020

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