Provider Demographics
NPI:1962560342
Name:PARKWAY DENTAL, P.C.
Entity type:Organization
Organization Name:PARKWAY DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:AMALGA
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-890-6174
Mailing Address - Street 1:402 E PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-4103
Mailing Address - Country:US
Mailing Address - Phone:479-890-6174
Mailing Address - Fax:479-967-0339
Practice Address - Street 1:402 E PARKWAY DR
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-4103
Practice Address - Country:US
Practice Address - Phone:479-890-6174
Practice Address - Fax:479-967-0339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty