| Mainline Dermott Dental Clinic | |
|
300 S School St Dermott AR 71638-2127 | |
| (870) 538-9720 | |
| (870) 538-9701 |
| Full Name | Mainline Dermott Dental Clinic |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 300 S School 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 |
|---|---|
| Mainline Dermott Dental Clinic Po Box 509 Dermott AR 71638-0509 Ph: (870) 942-3000 | Mainline Dermott Dental Clinic 300 S School St Dermott AR 71638-2127 Ph: (870) 538-9720 |
| NPI Number | 1417064890 |
|---|---|
| Provider Enumeration Date | 08/23/2006 |
| Last Update Date | 07/10/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417064890 | NPI | - | NPPES |
| 152991631 | 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 |
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 | |
Dermott School Dental Clinic Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 525 E Speedway St, Dermott, AR 71638 Phone: 870-538-5414 Fax: 870-538-5412 |