Healthcare Provider Details

I. General information

NPI: 1720621386
Provider Name (Legal Business Name): JAMES ROBLEE DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 E SUNBRIDGE DR
FAYETTEVILLE AR
72703-2830
US

IV. Provider business mailing address

1598 E AMBER DR
FAYETTEVILLE AR
72703-3087
US

V. Phone/Fax

Practice location:
  • Phone: 479-313-2772
  • Fax:
Mailing address:
  • Phone: 479-313-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4397
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number4397
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: