Provider Demographics
NPI:1265643720
Name:DENNIS, CAROL R (B S, R D H)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:R
Last Name:DENNIS
Suffix:
Gender:F
Credentials:B S, R D H
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 LACROSSE DR.
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022
Mailing Address - Country:US
Mailing Address - Phone:501-658-3556
Mailing Address - Fax:501-257-2206
Practice Address - Street 1:3518 LACROSSE
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-9314
Practice Address - Country:US
Practice Address - Phone:501-658-3556
Practice Address - Fax:501-257-2206
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA561124Q00000X
TX2902124Q00000X
AR1679124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist