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NPI

 2

Facility Name

 Take Kroger Survey to win $5k

First Name

 Krogerfeedback

Last Name

 survey

Physical Street Address -- NOTE:  Please return to complete this Survey separately for each physical service location where you provide dental services.

 How to Take Part In KrogerFeedback? Taking the Kroger survey and entering the lottery is easy, All you have to do is  Visit https://www.thekrogerfeedback.com from your personal computer or mobile phone. Don’t forget to have your receipt with you.

Physical City

 Little Rock

Physical State (Please use state abbreviation ex: ME for Maine)

 Newport

Physical Zip Code

 99,501

Are you currently accepting new MaineCare members?

 Yes

Are you able to accommodate children with special needs?

 Yes

Are you able to serve children with mobility issues such as wheelchair ramps and wider doorways?

 Yes

Are you able to provide services to children with complex health needs such as sedation?

 Yes

Are you able to provide services to children with intellectual disabilities such as autism?

 Yes

Dental License Number

 https://serc.carleton.edu/person/126598.html
Created at 11/13/2019 2:11 AM by ***
Last modified at 11/13/2019 2:11 AM by ***