Organization
MAINLINE HEALTH SYSTEMS, INC
Active
Other names
WILMOT DENTAL CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
GARY ALLAN NICHOLS (CEO)
(870) 538-5414
Entity
Organization
Contact information
Practice address
203 MCCOMB ST, WILMOT, AR 71676
(870) 473-2274
(870) 473-5392
Mailing address
PO BOX 100, PORTLAND, AR 71663-0100
(870) 737-2737
(870) 737-9780
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112127631
—
AR
Enumeration date
09/12/2006
Last updated
06/11/2020
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