Organization
MARTY J. HARDERSON, DDS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA ANNETTE ALSTON RDA (OFFICE MANAGER)
(479) 754-4076
Entity
Organization
Contact information
Practice address
1408 E MAIN ST, CLARKSVILLE, AR 72830-9436
(479) 754-4076
(479) 754-4078
Mailing address
1408 E MAIN ST, CLARKSVILLE, AR 72830-9436
(479) 754-4076
(479) 754-4078
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2952
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117894608
—
AR
01
—
1598701807
TYPE I NPI
AR
Enumeration date
09/20/2011
Last updated
09/20/2011
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