Individual
DR. SAM R. SHANLEVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
9755 W STATE HIGHWAY 22, RATCLIFF, AR 72951-9000
(479) 635-5300
(479) 635-2010
Mailing address
PO BOX 130, RATCLIFF, AR 72951-0130
(479) 635-5300
(479) 635-2010
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2285
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103823608
—
AR
01
—
58898
BLUE CROSS BLUE SHIELD
AR
01
—
846647
UNITED CONCORDIA
AR
Enumeration date
10/04/2006
Last updated
03/02/2010
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