| Dermott School Dental Clinic | |
|
525 E Speedway St Dermott AR 71638-2322 | |
| (870) 538-5414 | |
| (870) 538-5412 |
| Full Name | Dermott School Dental Clinic |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 525 E Speedway St, Dermott, Arkansas |
| Authorized Official Name and Position | Gary Allan Nichols (CEO) |
| Authorized Official Contact | 8709423000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dermott School Dental Clinic Po Box 509 Dermott AR 71638-0509 Ph: (870) 942-3000 | Dermott School Dental Clinic 525 E Speedway St Dermott AR 71638-2322 Ph: (870) 538-5414 |
| NPI Number | 1891245809 |
|---|---|
| Provider Enumeration Date | 10/13/2016 |
| Last Update Date | 07/10/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891245809 | NPI | - | NPPES |
| 217955631 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Mainline Dermott Dental Clinic Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 300 S School St, Dermott, AR 71638 Phone: 870-538-9720 Fax: 870-538-9701 | |
Marvin D. Loyd, Dds Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 880 E Gaines St, Dermott, AR 71638 Phone: 870-538-2046 Fax: 870-538-3609 |