Individual
DR. RAY E COLCLASURE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
550 W 46TH AVE, PINE BLUFF, AR 71603-7134
(870) 536-4567
(870) 536-3580
Mailing address
550 W 46TH AVE, PINE BLUFF, AR 71603-7134
(870) 536-4567
(870) 536-3580
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2047
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58101
AR BLUE CROSS BLUE SHEILD
AR
01
—
98892
UNITED CONCORDIA PROVIDER
AR
Enumeration date
07/17/2006
Last updated
07/08/2007
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