Southern Dental Group, PLLC
Dentist in Wynne, AR. Organization (NPI-2).
NPI number1134597206
StatusActive
Last updated in NPPESSep 8, 2015
Details
- NPI
- 1134597206
- Entity type
- Organization (NPI-2)
- Legal business name
- Southern Dental Group, PLLC
- Organization subpart
- No
- Enumeration date
- Sep 8, 2015
- Last updated
- Sep 8, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 3930 | AR | Yes |
Practice location
2100 Killough Rd NWynne, AR 72396-1009
Phone 870-243-4406
Mailing address
Po Box 17151Jonesboro, AR 72403-6720
Phone 870-243-4406
Authorized official
William Reynolds Little
Owner
8702434406
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