Organization
HEATHMAN FAMILY DENTAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TANK PAM (OFFICE MANAGER)
(501) 223-3838
Entity
Organization
Contact information
Practice address
12501 CANTRELL RD, LITTLE ROCK, AR 72223-1639
(501) 223-3838
(501) 223-2554
Mailing address
12501 CANTRELL RD, LITTLE ROCK, AR 72223-1639
(501) 223-3838
(501) 223-2554
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102068608
—
AR
01
—
2158
DELTA DENTAL
AR
01
—
58928
BLUECROSSBLUESHIELD INDIV
AR
01
—
5F438
BCBS PRACTICE #
AR
01
—
617338
UNITED CONCORDIA
AR
Enumeration date
05/21/2007
Last updated
08/19/2020
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