Healthcare Provider Details

I. General information

NPI: 1770274532
Provider Name (Legal Business Name): ALEXIS BALISTERRI ROUNTREE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 HORIZON DR
BRYANT AR
72022-9162
US

IV. Provider business mailing address

6084 CORAL RIDGE DR
ALEXANDER AR
72002-8084
US

V. Phone/Fax

Practice location:
  • Phone: 501-847-1022
  • Fax:
Mailing address:
  • Phone: 501-772-5006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4657
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: