Organization
J.M. LALLY, DDS, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN LALLY DDS, LTD (OWNER)
(870) 222-3926
Entity
Organization
Contact information
Practice address
601 N 2ND ST, MC GEHEE, AR 71654-2005
(870) 222-3926
Mailing address
601 N 2ND ST, MC GEHEE, AR 71654-2005
(870) 222-3926
(870) 222-4002
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2164
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102093608
—
AR
Enumeration date
04/17/2008
Last updated
04/17/2008
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