Organization
FAITH DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LILLIAM MARGARITA PRADO D.D.S (PRESIDENT)
(501) 562-1665
Entity
Organization
Contact information
Practice address
8211 GEYER SPRINGS RD, LITTLE ROCK, AR 72209-4952
(501) 562-1665
(501) 562-1667
Mailing address
8211 GEYER SPRINGS RD, LITTLE ROCK, AR 72209-4952
(501) 562-1665
(501) 562-1667
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163107608
—
AR
01
—
B/S 5Y875
BLUE CROSS BLUE SHIELD
AR
Enumeration date
05/21/2008
Last updated
05/21/2008
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