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Organization

ROBERT R. CARLISLE, D.D.S.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ROBERT R. CARLISLE (OWNER)
(501) 776-0564
Entity
Organization

Contact information

Practice address
818 W SOUTH ST, BENTON, AR 72015-4162
(501) 776-0564
Mailing address
818 W SOUTH ST, BENTON, AR 72015-4162
(501) 776-0564

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
AR2501
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
58939
BLUE CROSS BLUE SHIELD
AR
01
675447
UNITED CONCORDIA
AR
Enumeration date
06/04/2007
Last updated
08/22/2020
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