Provider Demographics
NPI:1699104109
Name:TRI LAKES DENTISTRY, PLLC
Entity type:Organization
Organization Name:TRI LAKES DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:DELEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-262-3100
Mailing Address - Street 1:2840 MALVERN AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-8320
Mailing Address - Country:US
Mailing Address - Phone:501-262-3100
Mailing Address - Fax:501-881-4259
Practice Address - Street 1:2840 MALVERN AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8320
Practice Address - Country:US
Practice Address - Phone:501-262-3100
Practice Address - Fax:501-881-4259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR35811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty