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Organization

PUCKETT DENTAL LLC

Active
Parent organization
PUCKETT DENTAL LLC
Other names
Pocahontas Smiles
Organization subpart
Yes

Provider details

NPI number
Legal business name
PUCKETT DENTAL LLC
Authorized official
DR. JOHN HARTLEY PUCKETT D.D.S. (OWNER)
(870) 236-5888
Entity
Organization

Contact information

Practice address
1041 HIGHWAY 67 NORTH, POCAHONTAS, AR 72455
(870) 236-5888
Mailing address
1041HWY. 67 N., POCAHONTAS, AR 72455
(870) 236-5888

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
3406
AR
261QD0000X
Dental Clinic/Center
3684
AR
261QD0000X
Dental Clinic/Center
4053
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1669608741
MO
05
176096608
AR
Enumeration date
07/10/2015
Last updated
07/10/2015
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