1518365048 NPI number — THE DENTAL CLINIC AT STUTTGART

Table of content: (NPI 1518365048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518365048 NPI number — THE DENTAL CLINIC AT STUTTGART

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE DENTAL CLINIC AT STUTTGART
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:
Provider Other Organization Name Type Code:
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:
1518365048
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/18/2019
NPI Reactivation Date:
02/06/2019

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2022 S BUERKLE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STUTTGART
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72160-6508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-673-6994
Provider Business Mailing Address Fax Number:
870-673-6995

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2022 S BUERKLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STUTTGART
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72160-6508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-673-6994
Provider Business Practice Location Address Fax Number:
870-673-6995
Provider Enumeration Date:
12/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
TANK
Authorized Official First Name:
PAM
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
870-551-3836

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com