Organization
AR DENTAL & TMJ - LITTLE ROCK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS ERIN CUPAN (PRACTICE ADMINISTRATOR)
(501) 225-1577
Entity
Organization
Contact information
Practice address
12018 CHENAL PKWY, LITTLE ROCK, AR 72211-2759
(501) 225-1577
(501) 219-4780
Mailing address
12018 CHENAL PKWY, LITTLE ROCK, AR 72211-2759
(501) 225-1577
(501) 219-4780
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
2268
AR
1223G0001X
General Practice Dentistry
Primary
—
AR
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
3966
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
180256679
—
AR
Enumeration date
11/04/2010
Last updated
03/21/2012
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