COLLEGE STATION DENTAL
NPI 1073886156
Dentist - General Practice in College Station, AR

Q: What is Jefferson Comprehensive Care System, Inc.'s specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Active since February 20, 2012CLIA 04D0466333 · Microscopy

4206 FRAZIER PIKE, COLLEGE STATION, AR 72053(501) 490-2440(501) 490-0156 Get Directions Write a Review

NPPES record last updated: February 20, 2012. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About College Station Dental NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COLLEGE STATION DENTAL (NPI 1073886156) is a healthcare organization registered as a general practice in College Station, Arkansas and active in the NPI registry since February 2012. The organization holds a CLIA Microscopy certificate valid through February 3, 2027 and lists Larnell W. Davis, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1073886156

Entity TypeOrganization

Primary Taxonomy1223G0001X

Legal Business NameJEFFERSON COMPREHENSIVE CARE SYSTEM, INC.

Location Address4206 FRAZIER PIKECollege Station, AR 72053-0668

Mailing AddressPo Box 1285Pine Bluff, AR 71613-1285 · (870) 536-5581 · Fax (870) 536-3565

Phone(501) 490-2440

Fax(501) 490-0156

Organization SubpartNo

Authorized OfficialLarnell W. DavisExecutive Director · (870) 543-2380

Enumeration DateFebruary 20, 2012

✔ NPI 1073886156 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

4206 FRAZIER PIKE, College Station, AR 72053

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Other Names 1

Doing Business AsCollege Station Dental

Other Identifiers 1

Other56811AR · Blue Cross Blue Shield

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 04D0466333

College Station Clinic · College Station, AR

Active · expires Feb 3, 2027

CLIA Number04D0466333

Laboratory TypeCommunity Clinic

Certificate Effective DateFebruary 4, 2025

Certificate Expiration DateFebruary 3, 2027

Laboratory DirectorDr. Marcus Crouther

Laboratory Phone(501) 490-2440

Laboratory LocationCollege Station Clinic4206 Frazier Pike, College Station, AR 72053

CLIA data matches this NPI record on: Address Phone

This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JEFFERSON COMPREHENSIVE CARE SYSTEM, INC

Clinic/Center (Federally Qualified Health Center (FQHC))

4206 FRAZIER PIKE
COLLEGE STATION, AR 72053

Pulaski County (501) 490-2440

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jefferson Comprehensive Care System, Inc.'s NPI number?

The NPI number for Jefferson Comprehensive Care System, Inc. is 1073886156. It was assigned to this organization in the NPPES registry on February 20, 2012. The provider is doing business as College Station Dental.

Where is Jefferson Comprehensive Care System, Inc. located?

Jefferson Comprehensive Care System, Inc. is located at 4206 Frazier Pike, College Station, AR 72053. The listed phone number is (501) 490-2440.

What is Jefferson Comprehensive Care System, Inc.'s specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Does Jefferson Comprehensive Care System, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 04D0466333) is associated with this NPI, valid through February 3, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Jefferson Comprehensive Care System, Inc. was last updated on February 20, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.