Provider Demographics
NPI:1306100136
Name:THE DENTAL CLINIC
Entity type:Organization
Organization Name:THE DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-352-6580
Mailing Address - Street 1:505 W PERSHING BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-2147
Mailing Address - Country:US
Mailing Address - Phone:501-758-9140
Mailing Address - Fax:
Practice Address - Street 1:505 W PERSHING BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-2147
Practice Address - Country:US
Practice Address - Phone:501-758-9140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty