Healthcare Provider Details

I. General information

NPI: 1265023378
Provider Name (Legal Business Name): THOMAS WARREN ROBLEE DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 E SUNBRIDGE DR
FAYETTEVILLE AR
72703-2830
US

IV. Provider business mailing address

162 E SUNBRIDGE DR
FAYETTEVILLE AR
72703-2830
US

V. Phone/Fax

Practice location:
  • Phone: 479-313-2552
  • Fax:
Mailing address:
  • Phone: 479-313-2552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4490
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: