Organization
PEDIATRIC DENTISTRY OF EASTERN ARKANSAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAORN RAE FRANKS RDA (RDA/OFFICE MANAGER)
(870) 630-1500
Entity
Organization
Contact information
Practice address
4941 N WASHINGTON HWY 1, FORREST CITY, AR 72335-3022
(870) 630-1500
(870) 630-6405
Mailing address
4941 N WASHINGTON, HIGHWAY 1, FORREST CITY, AR 72335-3022
(870) 630-1500
(870) 630-6405
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
3045
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
59632
BLUE CROSS BLUE SHIELD
AR
01
—
862131
UNITED CONCORDIA
AR
Enumeration date
08/28/2007
Last updated
08/28/2007
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