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Organization

TOLAND DENTAL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JENNIFER JOHNSON OFFICE MANAGER (OFFICE MANAGER)
(870) 238-0400
Entity
Organization

Contact information

Practice address
2100 KILLOUGH RD N, WYNNE, AR 72396-1009
(870) 238-0400
(870) 238-0417
Mailing address
2100 KILLOUGH RD N, WYNNE, AR 72396-1009
(870) 238-0400
(870) 238-0417

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2262
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
102049608
AR
01
58929
BLUE CROSS BLUE SHIELD INSURANCE
01
779622
UNITED CONCORDIA INSURANCE
Enumeration date
12/15/2009
Last updated
12/15/2009
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