| College Station Dental | |
|
4206 Frazier Pike College Station AR 72053-0668 | |
| (501) 490-2440 | |
| (501) 490-0156 |
| Full Name | College Station Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4206 Frazier Pike, College Station, Arkansas |
| Authorized Official Name and Position | Larnell W. Davis (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8705432380 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| College Station Dental Po Box 1285 Pine Bluff AR 71613-1285 Ph: (870) 536-5581 | College Station Dental 4206 Frazier Pike College Station AR 72053-0668 Ph: (501) 490-2440 |
| NPI Number | 1073886156 |
|---|---|
| Provider Enumeration Date | 02/20/2012 |
| Last Update Date | 02/20/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073886156 | NPI | - | NPPES |
| 56811 | Other | AR | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |