| Ridge Kids Dental | |
|
624 W Court St Suite A Paragould AR 72450-4247 | |
| (870) 236-5888 | |
| (870) 236-6888 |
| Full Name | Ridge Kids Dental |
|---|---|
| Speciality | Dentist |
| Location | 624 W Court St, Paragould, Arkansas |
| Authorized Official Name and Position | John Hartley Puckett (OWNER) |
| Authorized Official Contact | 8702365888 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ridge Kids Dental Po Box 1209 Paragould AR 72451-1209 Ph: (870) 236-5888 | Ridge Kids Dental 624 W Court St Suite A Paragould AR 72450-4247 Ph: (870) 236-5888 |
| NPI Number | 1669608741 |
|---|---|
| Provider Enumeration Date | 06/03/2009 |
| Last Update Date | 03/17/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669608741 | NPI | - | NPPES |
| 176117631 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 3406 (Arkansas) | Primary |
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