1396923371 NPI number — WILLIAM L. EGGART, JR, DDS, PA

Table of content: (NPI 1396923371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396923371 NPI number — WILLIAM L. EGGART, JR, DDS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM L. EGGART, JR, DDS, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MORRILTON FAMILY DENTAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396923371
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 MEDICAL SERVICES DR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
MORRILTON
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72110-4528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-354-8800
Provider Business Mailing Address Fax Number:
501-354-8801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 MEDICAL SERVICES DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MORRILTON
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72110-4528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-354-8800
Provider Business Practice Location Address Fax Number:
501-354-8801
Provider Enumeration Date:
02/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
EGGART
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
501-354-8800

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  3394 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 152718608 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1579726 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 5X712 . This is a "BCBS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com