Organization
HERITAGE LEGACY DENTAL CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WADE ROBERTSON DDS (PRESIDENT)
(501) 771-4500
Entity
Organization
Contact information
Practice address
7 EDENWOOD LN, N LITTLE ROCK, AR 72116-5105
(501) 771-4500
(901) 763-3573
Mailing address
7 EDENWOOD LN, N LITTLE ROCK, AR 72116-5105
(501) 771-4500
(901) 763-3573
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3220
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
217518608
—
AR
Enumeration date
02/08/2017
Last updated
02/08/2017
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