Heritage Legacy Dental Care, Inc | |
7 Edenwood Ln N Little Rock AR 72116-5105 | |
(501) 771-4500 | |
(901) 763-3573 |
Full Name | Heritage Legacy Dental Care, Inc |
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Speciality | Dentist |
Location | 7 Edenwood Ln, N Little Rock, Arkansas |
Authorized Official Name and Position | Wade Robertson (PRESIDENT) |
Authorized Official Contact | 5017714500 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Heritage Legacy Dental Care, Inc 7 Edenwood Ln N Little Rock AR 72116-5105 Ph: (501) 771-4500 | Heritage Legacy Dental Care, Inc 7 Edenwood Ln N Little Rock AR 72116-5105 Ph: (501) 771-4500 |
NPI Number | 1659819738 |
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Provider Enumeration Date | 02/08/2017 |
Last Update Date | 02/08/2017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1659819738 | NPI | - | NPPES |
217518608 | Medicaid | AR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 3220 (Arkansas) | Primary |