Provider Demographics
NPI:1053703249
Name:AXPM ORAL SURGERY PLLC
Entity type:Organization
Organization Name:AXPM ORAL SURGERY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:501-781-2777
Mailing Address - Street 1:5100 TALLEY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-8032
Mailing Address - Country:US
Mailing Address - Phone:501-781-2777
Mailing Address - Fax:501-781-2778
Practice Address - Street 1:2305 SPRINGHILL RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72019-7552
Practice Address - Country:US
Practice Address - Phone:501-408-4774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARK L. DAKE, DDS, MSD AND BRYAN C. HILLER, DMD, MS ORTHODONTIC ASSOCI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty