Organization
JEFFERSON COMPREHENSIVE CARE SYSTEM INC
Active
Other names
Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARNELL W DAVIS (EXECUTIVE DIRECTOR)
(870) 543-2380
Entity
Organization
Contact information
Practice address
1101 TENNESSEE ST, PINE BLUFF, AR 71601-5801
(870) 543-2341
(870) 535-4716
Mailing address
PO BOX 1285, PINE BLUFF, AR 71613-1285
(870) 543-2341
(870) 535-4716
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102953631
—
AR
Enumeration date
06/06/2008
Last updated
06/06/2008
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