1821299645 NPI number — ROBBIE R. ATKINSON, DDS,MD,LTD.

Table of content: (NPI 1821299645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821299645 NPI number — ROBBIE R. ATKINSON, DDS,MD,LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBBIE R. ATKINSON, DDS,MD,LTD.
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:
1821299645
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 W 40TH AVE
Provider Second Line Business Mailing Address:
STE. 2-A
Provider Business Mailing Address City Name:
PINE BLUFF
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71603-6940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-534-7860
Provider Business Mailing Address Fax Number:
870-534-5327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 W 40TH AVE
Provider Second Line Business Practice Location Address:
STE. 2-A
Provider Business Practice Location Address City Name:
PINE BLUFF
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71603-6940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-534-7860
Provider Business Practice Location Address Fax Number:
870-534-5327
Provider Enumeration Date:
05/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PIPES
Authorized Official First Name:
LIQUINTA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
870-534-7860

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  2328 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 305R00000X , with the licence number: C5909 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 2328 . This is a "DENTIST" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: C5909 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 50161 . This is a "BCBS PROVIDER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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