Provider Demographics
NPI:1447875729
Name:WARDLAW ORTHODONTICS, P.A.
Entity type:Organization
Organization Name:WARDLAW ORTHODONTICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:COVERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-227-5757
Mailing Address - Street 1:8315 CANTRELL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-2354
Mailing Address - Country:US
Mailing Address - Phone:501-227-5757
Mailing Address - Fax:501-227-0139
Practice Address - Street 1:8315 CANTRELL RD STE 100
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-2354
Practice Address - Country:US
Practice Address - Phone:501-227-5757
Practice Address - Fax:501-227-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty