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Organization
ARKANSAS DENTAL PROFESSIONALS, MONGRAIN, P.A
Active
Organization
ARKANSAS DENTAL PROFESSIONALS, MONGRAIN, P.A
Active
Other names
Arkadelphia Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
HANNAH FISH (CREDENTIALING COORDINATOR)
(217) 540-5699
Entity
Organization
Contact information
Practice address
3003 TWIN RIVERS DR, ARKADELPHIA, AR 71923-4219
(870) 246-2242
(870) 246-2495
Mailing address
3003 TWIN RIVERS DR, ARKADELPHIA, AR 71923-4219
(870) 246-2242
(870) 246-2495
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2256
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
172175631
—
AR
Enumeration date
11/24/2008
Last updated
05/10/2019
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