Organization
ARKANSAS DENTAL PROFESSIONALS MONGRAIN PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIE KUHL (DIRECTOR OF DENTAL INSURANCE)
(217) 540-5146
Entity
Organization
Contact information
Practice address
2909 S 74TH ST, FORT SMITH, AR 72903-5156
(479) 452-7454
(479) 484-5908
Mailing address
2909 S 74TH ST, FORT SMITH, AR 72903-5156
(479) 452-7454
(479) 484-5908
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
162147631
—
AR
05
—
200078290A
—
OK
Enumeration date
02/12/2007
Last updated
07/20/2020
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