Provider Demographics
NPI:1487939542
Name:LITTLE ROCK DENTISTRY
Entity type:Organization
Organization Name:LITTLE ROCK DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRADFORD
Authorized Official - Last Name:CRUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:501-224-6333
Mailing Address - Street 1:9601 LILE DR
Mailing Address - Street 2:SUITE 950
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6321
Mailing Address - Country:US
Mailing Address - Phone:501-224-6333
Mailing Address - Fax:501-224-7222
Practice Address - Street 1:9601 LILE DR
Practice Address - Street 2:SUITE 950
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6321
Practice Address - Country:US
Practice Address - Phone:501-224-6333
Practice Address - Fax:501-224-7222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR38341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty