Individual
DR. MAURICE LOUIE ALLRED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
9 MOHAWK CIR, LITTLE ROCK, AR 72207-2515
(501) 804-4973
Mailing address
9 MOHAWK CIR, LITTLE ROCK, AR 72207-2515
(501) 804-4973
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
AR1806
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58242
PRACTICE BCBS ID
AR
01
—
71-0775709
PRACTICE TAX ID
AR
01
—
AR1806
STATE DENTAL LICENSE
AR
Enumeration date
03/06/2007
Last updated
07/10/2012
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