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Organization

INTERDISCIPLINARY DENTAL THERAPY, P.A.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MONTGOMERY DWIGHT HEATHMAN D.D.S. (PRESIDENT/CEO)
(479) 856-5588
Entity
Organization

Contact information

Practice address
9200 CHICOT RD, LITTLE ROCK, AR 72209-6107
(501) 562-3029
(501) 568-1823
Mailing address
9200 CHICOT RD, LITTLE ROCK, AR 72209-6107
(501) 562-3029
(501) 568-1823

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
AR3333
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
161458608
AR
Enumeration date
01/06/2013
Last updated
01/06/2013
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