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General NPI Number Information
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NPI Number | 1487937629
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Entity Type | Organization
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Legal Business Name | CENTERSTONE FAMILY DENTISTRY, PLLC
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Dates
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Enumeration Date | 09/23/2011
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Last Update Date | 09/23/2011
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Provider Practice Location Address
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Address Line | 2235 DAVE WARD DR SUITE 103
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City | CONWAY
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State | AR
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Zip | 72034-7039
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Country | US
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Telephone | 501-932-0192
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Fax | 501-932-0211
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Provider Business Mailing Address
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Address Line | 2235 DAVE WARD DR SUITE 103
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City | CONWAY
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State | AR
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Zip | 72034-7039
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Country | US
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Telephone | 501-932-0192
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Fax | 501-932-0211
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Authorized Official
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Title or Position | OWNER/ GENERAL DENTIST
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Name | DR. ROBERT CARLISLE
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Credential | D.D.S.
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Telephone | 501-932-0192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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