1598812224 NPI number — CALVIN B. SUFFRIDGE, DDS, PA

Table of content: (NPI 1598812224)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598812224 NPI number — CALVIN B. SUFFRIDGE, DDS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALVIN B. SUFFRIDGE, 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:
Provider Other Organization Name Type Code:
6
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:
1598812224
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 PARKSTONE CIR
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
NORTH LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72116-7086
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-907-6000
Provider Business Mailing Address Fax Number:
501-907-5664

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 PARKSTONE CIR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
NORTH LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72116-7086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-907-6000
Provider Business Practice Location Address Fax Number:
501-907-5664
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SUFFRIDGE
Authorized Official First Name:
CALVIN
Authorized Official Middle Name:
BUFORD
Authorized Official Title or Position:
ENDODONTIST
Authorized Official Telephone Number:
501-907-6000

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  3182 , 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: 5X097 . This is a "BCBS HEALTH ADVANTAGE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 1388393 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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