Healthcare Provider Details

I. General information

NPI: 1073676359
Provider Name (Legal Business Name): CARL S PLYLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 ELM ST
GLENWOOD AR
71943
US

IV. Provider business mailing address

119 ELM ST PO BOX 4
GLENWOOD AR
71943
US

V. Phone/Fax

Practice location:
  • Phone: 870-356-3920
  • Fax: 870-356-4163
Mailing address:
  • Phone: 870-356-3920
  • Fax: 870-356-4163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2690
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: