Organization
AXPM-MOUNTAIN HOME DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK DAKE (OWNER)
(501) 781-2777
Entity
Organization
Contact information
Practice address
500 HOSPITAL DR, MOUNTAIN HOME, AR 72653-2913
(870) 425-9757
Mailing address
PO BOX 3450, LITTLE ROCK, AR 72203-3450
(501) 781-2777
(501) 781-2778
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
AR
Other
Enumeration date
01/04/2017
Last updated
01/04/2017
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