Provider Demographics
NPI:1881721595
Name:WHITEHEAD, ROBERT E (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:WHITEHEAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 ARKANSAS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1664
Mailing Address - Country:US
Mailing Address - Phone:870-773-3109
Mailing Address - Fax:870-774-0451
Practice Address - Street 1:1600 ARKANSAS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1664
Practice Address - Country:US
Practice Address - Phone:870-773-3109
Practice Address - Fax:870-774-0451
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR21751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice