1548442809 NPI number — ASHLEY JACKSON PLUMMER,D.D.S., P.A.

Table of content: (NPI 1548442809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548442809 NPI number — ASHLEY JACKSON PLUMMER,D.D.S., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASHLEY JACKSON PLUMMER,D.D.S., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548442809
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
123 W GROVE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL DORADO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71730-4608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-864-0338
Provider Business Mailing Address Fax Number:
870-864-0229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 W GROVE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL DORADO
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71730-4608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-864-0338
Provider Business Practice Location Address Fax Number:
870-864-0229
Provider Enumeration Date:
11/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PLUMMER
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
JACKSON
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
870-864-0338

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  3443 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 152114608 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5X453 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com