Provider Demographics
NPI:1114399946
Name:REBECCA CARLISLE D.D.S. L.L.C.
Entity Type:Organization
Organization Name:REBECCA CARLISLE D.D.S. L.L.C.
Other - Org Name:WEDINGTON COURT DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLISLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-527-0707
Mailing Address - Street 1:1188 N SALEM RD
Mailing Address - Street 2:STE 10
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-8807
Mailing Address - Country:US
Mailing Address - Phone:479-527-0707
Mailing Address - Fax:
Practice Address - Street 1:1188 N SALEM RD
Practice Address - Street 2:STE 10
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-8807
Practice Address - Country:US
Practice Address - Phone:479-527-0707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3827122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty