Organization
MAINLINE HEALTH SYSTEMS, INC
Active
Other names
MAINLINE DERMOTT DENTAL CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
GARY ALLAN NICHOLS (CEO)
(870) 942-3000
Entity
Organization
Contact information
Practice address
300 S SCHOOL ST, DERMOTT, AR 71638-2127
(870) 538-9720
(870) 538-9701
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
—
152991631
—
AR
Enumeration date
08/23/2006
Last updated
07/10/2024
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