John William Antonetz, DDS
Individual provider Active NPI Public Health Dentistry · North Little Rock, AR
NPI 1255422622 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1255422622
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Public Health Dentistry 1223D0001X
- License
- 030938 (NY)
- Practice address
- 2200 Fort Roots Dr
North Little Rock, AR 72114-1709 - Phone
- (501) 257-1000
- NPI assigned
- Sep 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health Dentistry | 1223D0001X | 030938 | NY | Yes |
Addresses
Primary practice location
2200 Fort Roots Dr
North Little Rock, AR 72114-1709
Mailing address
11127 Gila Valley Dr
Little Rock, AR 72212-3505
Phone (501) 225-9437
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All providers in North Little Rock, AR · Public Health Dentistry in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.