Individual
DALE E COLCLASURE SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2501 CRESTWOOD, STE 103, NORTH LITTLE ROCK, AR 72116
(501) 758-3393
(501) 758-4346
Mailing address
32 RIVER ESTATES COVE, LITTLE ROCK, AR 72112
(501) 868-5966
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2111
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58089
BLUE CROSS BLUE SHIELD
AR
01
—
801533
UNITED CONCORDIA
AR
Enumeration date
10/10/2006
Last updated
07/08/2007
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