Provider Demographics
NPI:1174698823
Name:SCALLION, TARA PAPPAS (DDS)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:PAPPAS
Last Name:SCALLION
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 ATWOOD RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-6012
Mailing Address - Country:US
Mailing Address - Phone:501-888-1197
Mailing Address - Fax:501-888-8800
Practice Address - Street 1:3401 ATWOOD RD
Practice Address - Street 2:SUITE D
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-6012
Practice Address - Country:US
Practice Address - Phone:501-888-1197
Practice Address - Fax:501-888-8800
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3189122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T518OtherAR BLUE CROSS NUMBER
AR603644OtherUNITED CONCORDIA
AR159516631Medicaid