Organization
ICD INC
Active
Parent organization
ICD INC.
Other names
DeAtley Dental Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
ICD INC.
Authorized official
DR. IRVIN MATTHEW DEATLEY D.D.S. (OWNER)
(870) 425-1441
Entity
Organization
Contact information
Practice address
320 E 7TH ST, MOUNTAIN HOME, AR 72653-4416
(870) 425-1441
(870) 425-1445
Mailing address
320 E 7TH ST, MOUNTAIN HOME, AR 72653-4416
(870) 425-1441
(870) 425-1445
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3573
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
161452631
—
AR
Enumeration date
04/13/2007
Last updated
06/19/2008
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