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Organization
MAINLINE HEALTH SYSTEMS, INC
Active
Organization
MAINLINE HEALTH SYSTEMS, INC
Active
Other names
WILMOT DENTAL CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
GARY ALLAN NICHOLS (CEO)
(870) 538-5414
Entity
Organization
Contact information
Practice address
203 MCCOMB ST, WILMOT, AR 71676
(870) 473-2274
(870) 473-5392
Mailing address
PO BOX 100, PORTLAND, AR 71663-0100
(870) 737-2737
(870) 737-9780
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112127631
—
AR
Enumeration date
09/12/2006
Last updated
06/11/2020
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