Provider Demographics
NPI:1720621386
Name:ROBLEE, JAMES (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:ROBLEE
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1598 E AMBER DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3087
Mailing Address - Country:US
Mailing Address - Phone:479-313-2772
Mailing Address - Fax:
Practice Address - Street 1:162 E SUNBRIDGE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2830
Practice Address - Country:US
Practice Address - Phone:479-313-2772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR43971223X0400X, 1223X2210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No1223X2210XDental ProvidersDentistOrofacial PainGroup - Single Specialty