Provider Demographics
NPI:1902105984
Name:SENIOR DENTAL CARE LLC.
Entity Type:Organization
Organization Name:SENIOR DENTAL CARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MATONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:1501-821-2214
Mailing Address - Street 1:25 RAHLING CIR STE C
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-9194
Mailing Address - Country:US
Mailing Address - Phone:150-182-1221
Mailing Address - Fax:150-182-1224
Practice Address - Street 1:25 RAHLING CIR STE C
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-9194
Practice Address - Country:US
Practice Address - Phone:501-821-2214
Practice Address - Fax:150-182-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2534302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR185153631Medicaid