MEDICARE: DR. ROBERT JOE MATLOCK DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1905	AR

General Provider Information

NPI Number	:	1487610093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT JOE MATLOCK DDS

Provider Business Mailing Address
First Line	:	1107 WEST ELM ST
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72756-4235
Country	:	US
Telephone Number	:	479-636-1194
Fax Number	:	479-636-8549

Provider Business Practice Location Address
First Line	:	1107 WEST ELM ST
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72756-4235
Country	:	US
Telephone Number	:	479-636-1194
Fax Number	:	479-636-8549

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2006
Last Update Date	:	07/08/2007

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