Organization
MAINLINE HEALTH SYSTEMS, INC
Active
Other names
Lakeside Dental
Organization subpart
No
Provider details
NPI number
Authorized official
GARY ALLAN NICHOLS (CEO)
(870) 942-3000
Entity
Organization
Contact information
Practice address
360A W HIGHWAY 82, LAKE VILLAGE, AR 71653-7501
(870) 201-2127
(888) 671-8943
Mailing address
342 HIGHWAY 425 S, MONTICELLO, AR 71655-4612
(870) 942-3000
(870) 942-3005
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
226028631
—
AR
Enumeration date
02/01/2017
Last updated
03/23/2026
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