Provider Demographics
NPI:1700094786
Name:HEATHMAN FAMILY DENTAL INC
Entity type:Organization
Organization Name:HEATHMAN FAMILY DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANK
Authorized Official - Middle Name:
Authorized Official - Last Name:PAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-223-3838
Mailing Address - Street 1:12501 CANTRELL RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-1639
Mailing Address - Country:US
Mailing Address - Phone:501-223-3838
Mailing Address - Fax:501-223-2554
Practice Address - Street 1:12501 CANTRELL RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-1639
Practice Address - Country:US
Practice Address - Phone:501-223-3838
Practice Address - Fax:501-223-2554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58928OtherBLUECROSSBLUESHIELD INDIV
AR102068608Medicaid
AR2158OtherDELTA DENTAL
AR5F438OtherBCBS PRACTICE #
AR617338OtherUNITED CONCORDIA