Provider Demographics
NPI:1518973353
Name:AINLEY FAMILY DENTAL CARE, PA
Entity type:Organization
Organization Name:AINLEY FAMILY DENTAL CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:AINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-239-2285
Mailing Address - Street 1:PO BOX 61
Mailing Address - Street 2:707 LINWOOD DRIVE
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72451-0061
Mailing Address - Country:US
Mailing Address - Phone:870-239-2285
Mailing Address - Fax:870-239-8871
Practice Address - Street 1:707 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4899
Practice Address - Country:US
Practice Address - Phone:870-239-2285
Practice Address - Fax:870-239-8871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR26131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR2613OtherSTATE LICENSE
ART20480Medicare UPIN