Provider Demographics
NPI:1386706224
Name:AEBERSOLD, ANITA L (DDS)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:L
Last Name:AEBERSOLD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2920
Mailing Address - Country:US
Mailing Address - Phone:501-664-1733
Mailing Address - Fax:501-664-1759
Practice Address - Street 1:820 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2920
Practice Address - Country:US
Practice Address - Phone:501-664-1733
Practice Address - Fax:501-664-1759
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR25001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice