| Mammoth Spring Dental Clinic, Llc | |
|
180 Main Street Mammoth Spring AR 72554 | |
| (870) 625-3262 | |
| (870) 625-3673 |
| Full Name | Mammoth Spring Dental Clinic, Llc |
|---|---|
| Speciality | Dentist |
| Location | 180 Main Street, Mammoth Spring, Arkansas |
| Authorized Official Name and Position | Michael D. Kersey (MEMBER) |
| Authorized Official Contact | 8706253262 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mammoth Spring Dental Clinic, Llc P.o. Box 128 Mammoth Spring AR 72554 Ph: (870) 625-3262 | Mammoth Spring Dental Clinic, Llc 180 Main Street Mammoth Spring AR 72554 Ph: (870) 625-3262 |
| NPI Number | 1023349651 |
|---|---|
| Provider Enumeration Date | 01/21/2010 |
| Last Update Date | 01/21/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023349651 | NPI | - | NPPES |
| 402069306 | Medicaid | MO | |
| 889-284 | Other | AR | UNITED CONCORDIA |
| 56593 | Other | AR | BLUE CROSS BLUE SHIELD |
| 102276608 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 2661 (Arkansas) | Primary |