Provider Demographics
NPI:1447086020
Name:MEAD FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:MEAD FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:D
Authorized Official - Last Name:MEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-698-1189
Mailing Address - Street 1:201 VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7335
Mailing Address - Country:US
Mailing Address - Phone:870-698-1189
Mailing Address - Fax:870-698-1188
Practice Address - Street 1:201 VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7335
Practice Address - Country:US
Practice Address - Phone:870-698-1189
Practice Address - Fax:870-698-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental