Individual
DR. JOHN M LALLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
601 N 2ND ST, MCGEHEE, AR 71654-2005
(870) 222-3926
(870) 222-4002
Mailing address
601 N 2ND ST, MCGEHEE, AR 71654-2005
(870) 222-3926
(870) 222-4002
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2164
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000834033
UNITED CONCORDIA PROVIDER
AR
05
—
139106631
—
AR
01
—
58382
BLUE CROSS BLUE SHIELD
AR
Enumeration date
07/19/2006
Last updated
07/09/2007
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