Organization
MAINLINE HEALTH SYSTEMS, INC
Active
Other names
Dermott School Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
GARY ALLAN NICHOLS (CEO)
(870) 942-3000
Entity
Organization
Contact information
Practice address
525 E SPEEDWAY ST, DERMOTT, AR 71638-2322
(870) 277-2658
(855) 811-4203
Mailing address
342 HIGHWAY 425 S, MONTICELLO, AR 71655-4612
(870) 942-3000
(870) 942-3005
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
217955631
—
AR
Enumeration date
10/13/2016
Last updated
03/20/2026
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