Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 2127 | AR |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 2721 | AR |
NPI | 1124074695 |
---|---|
Provider Name | Dr. Anthony L. Tortorich |
First Address | Little Rock, AR 72212-2453 |
Second Address | Little Rock, AR 72212-2453 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 23/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T20586 | (02) | AR |