Healthcare Provider Details

I. General information

NPI: 1003052234
Provider Name (Legal Business Name): ROBERT E. ANDERSON, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT VINCENT CIR STE 240
LITTLE ROCK AR
72205-5407
US

IV. Provider business mailing address

1 SAINT VINCENT CIR STE 240
LITTLE ROCK AR
72205-5407
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-3900
  • Fax: 501-663-6076
Mailing address:
  • Phone: 501-664-3900
  • Fax: 501-663-6076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1729
License Number StateAR

VIII. Authorized Official

Name: DR. ROBERT E ANDERSON
Title or Position: ORAL & MAXILLOFACIAL SURGEON
Credential: DDS
Phone: 501-664-3900