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2729 S. Hwy 65 82 Lake Village AR 71653 | |
| (870) 265-5351 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2729 S. Hwy 65 82, Lake Village, Arkansas |
| Authorized Official Name and Position | Susan Vaughn (CFO) |
| Authorized Official Contact | 8702659229 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2729 S Highway 65 82 Lake Village AR 71653-6136 Ph: () - | 2729 S. Hwy 65 82 Lake Village AR 71653 Ph: (870) 265-5351 |
| NPI Number | 1861901985 |
|---|---|
| Provider Enumeration Date | 09/20/2017 |
| Last Update Date | 06/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861901985 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |