Organization
MAINLINE HEALTH SYSTEMS, INC
Active
Other names
Warren Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
GARY ALLAN NICHOLS (CEO)
(870) 942-3000
Entity
Organization
Contact information
Practice address
931 N MYRTLE ST, BUILDING D, WARREN, AR 71671
(870) 355-2512
(855) 754-0598
Mailing address
PO BOX 509, DERMOTT, AR 71638-0509
(870) 942-3000
(870) 538-5412
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
—
280277631
—
AR
Enumeration date
10/22/2021
Last updated
04/01/2025
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