Healthcare Provider Details

I. General information

NPI: 1063591063
Provider Name (Legal Business Name): NLR ORAL & MAXILLOFACIAL SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 JFK BLVD
NO. LITTLE ROCK AR
72116
US

IV. Provider business mailing address

3001 JFK BLVD
NO. LITTLE ROCK AR
72116
US

V. Phone/Fax

Practice location:
  • Phone: 501-758-3095
  • Fax:
Mailing address:
  • Phone: 501-758-3095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ROBERT D. KEENE
Title or Position: PARTNER
Credential: DDS
Phone: 501-758-3095