Provider Demographics
NPI:1265448484
Name:GAINES, KARLA KAY (DDS)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:KAY
Last Name:GAINES
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 1:802 N DIXIELAND RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756
Mailing Address - Country:US
Mailing Address - Phone:479-936-8800
Mailing Address - Fax:479-936-8808
Practice Address - Street 1:802 N DIXIELAND RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756
Practice Address - Country:US
Practice Address - Phone:479-936-8800
Practice Address - Fax:479-936-8808
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3098122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59982OtherBCBS
AR109051OtherUNITED CONCORDIA
AR125300608Medicaid
AR3098OtherDENTAL LICENSE NUMBER