Provider Demographics
NPI:1598854176
Name:RICHARD D. ROBLEE DDS
Entity Type:Organization
Organization Name:RICHARD D. ROBLEE DDS
Other - Org Name:ROBLEE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ROBLEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:479-521-6060
Mailing Address - Street 1:162 E SUNBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-2830
Mailing Address - Country:US
Mailing Address - Phone:479-521-6060
Mailing Address - Fax:479-521-4161
Practice Address - Street 1:162 E SUNBRIDGE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703
Practice Address - Country:US
Practice Address - Phone:479-521-6060
Practice Address - Fax:479-521-4161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR27201223X0400X
AR34121223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14242OtherRDR TEXAS LICENSE
OK200046150 AOtherOK SOONERCARE RDR
OK200046160 AOtherOK SOONERCARE JML
OK154OtherJML OKLAHOMA LICENSE
ARU06567OtherBCBS UPIN
AR155641608Medicaid
AR5F054OtherBCBS GROUP ID #
OK200046140 AOtherOK SOONERCARE GROUP ID
AR3412OtherJML ARKANSAS LICENSE
AR58127OtherBCBS ID #
AR887681OtherUNITED CONCORDIA ID #
AR2720OtherRDR ARKANSAS LICENSE