1972038628 NPI number — MICHAEL ASHCRAFT D.D.S., M.S., P.A.

Table of content: (NPI 1972038628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972038628 NPI number — MICHAEL ASHCRAFT D.D.S., M.S., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL ASHCRAFT D.D.S., M.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:
1972038628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23 SHACKLEFORD DR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72211-2859
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-225-3964
Provider Business Mailing Address Fax Number:
501-225-8964

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23 SHACKLEFORD DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72211-2859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-225-3964
Provider Business Practice Location Address Fax Number:
501-225-8964
Provider Enumeration Date:
05/01/2017

Additional Information

Authorized Official

Authorized Official Last Name:
FLAKOLL
Authorized Official First Name:
AUDREY
Authorized Official Middle Name:
Authorized Official Title or Position:
TREATMENT & FINANCIAL COORDINATOR
Authorized Official Telephone Number:
501-225-3964

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  2838 , 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: 207606631 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117909608 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com