Provider Demographics
NPI:1114666948
Name:NOLAND, CHARLES CONNER
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:CONNER
Last Name:NOLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-2516
Mailing Address - Country:US
Mailing Address - Phone:501-362-0550
Mailing Address - Fax:
Practice Address - Street 1:607 N 2ND ST
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-2516
Practice Address - Country:US
Practice Address - Phone:501-362-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4594122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist