Provider Demographics
NPI:1861098816
Name:ANDREA DENSON-MEANS DMD
Entity type:Organization
Organization Name:ANDREA DENSON-MEANS DMD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:DENSON-MEANS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:870-633-4894
Mailing Address - Street 1:PO BOX 999
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72336-0999
Mailing Address - Country:US
Mailing Address - Phone:870-633-4894
Mailing Address - Fax:
Practice Address - Street 1:420 E COOK ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-2869
Practice Address - Country:US
Practice Address - Phone:870-633-4894
Practice Address - Fax:870-633-4965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR161848608Medicaid