Southern Dental Group, PLLC

Primary specialty

DentistTaxonomy code 122300000X

License

3930 Issued in AR

Legal business name

SOUTHERN DENTAL GROUP, PLLC

Practice address

2100 Killough Rd N
Wynne, AR 72396-1009

Phone

(870) 243-4406

NPI assigned

Sep 8, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. William Reynolds Little, D.D.S.

Title

Owner

Phone

(870) 243-4406

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1441670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441670400000",
    "number": "1134597206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17151",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724036720",
            "telephone_number": "870-243-4406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 KILLOUGH RD N",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723961009",
            "telephone_number": "870-243-4406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN DENTAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-08",
        "last_updated": "2015-09-08",
        "status": "A",
        "authorized_official_last_name": "LITTLE",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "REYNOLDS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "870-243-4406",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "AR",
            "license": "3930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.