Provider Demographics
NPI:1922569573
Name:LE WESTERN DENTISTRY, PLLC
Entity type:Organization
Organization Name:LE WESTERN DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CASSI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WORK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-782-3005
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:AR
Mailing Address - Zip Code:72933-0308
Mailing Address - Country:US
Mailing Address - Phone:479-965-2291
Mailing Address - Fax:479-965-2292
Practice Address - Street 1:16 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:AR
Practice Address - Zip Code:72933-9190
Practice Address - Country:US
Practice Address - Phone:479-965-2291
Practice Address - Fax:479-965-2292
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LE WESTERN DENTISTRY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1154867893OtherGROUP NPI