MEDICARE: LANDMARK DENTAL CENTER

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	261QD0000X	Dental Clinic/Center	3189	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972714798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANDMARK DENTAL CENTER

Provider Business Mailing Address
First Line	:	3401 ATWOOD RD
Second Line	:	SUITE D
City	:	LITTLE ROCK
State	:	AR
Zip	:	72206-6012
Country	:	US
Telephone Number	:	501-888-1197
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 ATWOOD RD
Second Line	:	SUITE D
City	:	LITTLE ROCK
State	:	AR
Zip	:	72206-6012
Country	:	US
Telephone Number	:	501-888-1197
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. TARA PAPPAS SCALLION
Credential	:	DDS
Telephone Number	:	501-888-1197

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	09/10/2009

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Directions to “LANDMARK DENTAL CENTER ” Practice Location

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