Organization
CHILDRENS DENTAL CLINIC OF JONESBORO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAUREN LEE (OFFICE MANAGER)
(870) 897-9465
Entity
Organization
Contact information
Practice address
217 E CHERRY AVE, JONESBORO, AR 72401-3372
(870) 897-2489
Mailing address
217 E CHERRY AVE, JONESBORO, AR 72401-3372
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023240595
—
AR
Enumeration date
04/04/2019
Last updated
12/22/2020
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