Provider Demographics
NPI:1033512678
Name:RUPPERT, ROBIN CRISTY (RDH)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:CRISTY
Last Name:RUPPERT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:CRISTY
Other - Last Name:LEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2200 FORT ROOTS DR
Mailing Address - Street 2:BLDG. 32- ROOM 109
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-1709
Mailing Address - Country:US
Mailing Address - Phone:501-257-1484
Mailing Address - Fax:501-257-1738
Practice Address - Street 1:2200 FORT ROOTS DR
Practice Address - Street 2:BLDG. 32- ROOM 109
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:501-257-1484
Practice Address - Fax:501-257-1738
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2511124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist