Provider Demographics
NPI:1487937629
Name:CENTERSTONE FAMILY DENTISTRY, PLLC
Entity type:Organization
Organization Name:CENTERSTONE FAMILY DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLISLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-932-0192
Mailing Address - Street 1:2235 DAVE WARD DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-7039
Mailing Address - Country:US
Mailing Address - Phone:501-932-0192
Mailing Address - Fax:501-932-0211
Practice Address - Street 1:2235 DAVE WARD DR
Practice Address - Street 2:SUITE 103
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-7039
Practice Address - Country:US
Practice Address - Phone:501-932-0192
Practice Address - Fax:501-932-0211
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT R. CARLISLE, D.D.S., PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty