Healthcare Provider Details

I. General information

NPI: 1699951996
Provider Name (Legal Business Name): ROBERT C GOLDTRAP DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 W FINANCIAL PKWY
ROGERS AR
72758-1449
US

IV. Provider business mailing address

4001 W FINANCIAL PKWY
ROGERS AR
72758-1449
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-8700
  • Fax:
Mailing address:
  • Phone: 479-636-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3242
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: