Provider Demographics
NPI:1003981283
Name:CARTILLAR, DJUANA LEIGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:DJUANA
Middle Name:LEIGH
Last Name:CARTILLAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4941 NORTH WASHINGTON/HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335
Mailing Address - Country:US
Mailing Address - Phone:870-630-1500
Mailing Address - Fax:870-630-6405
Practice Address - Street 1:4941 NORTH WASHINGTON/HIGHWAY1
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335
Practice Address - Country:US
Practice Address - Phone:870-630-1500
Practice Address - Fax:870-630-6405
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR30451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59632OtherBCBS PROVIDER #
AR123626608Medicaid
AR710851189OtherTAX IDENTIFICATION NUMBER
AR862131OtherUNITED CONCORDIA NUMBER