Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 3045 | AR |
NPI | 1003981283 |
---|---|
Provider Name | Dr. Djuana Leigh Cartillar |
First Address | Forrest City, AR 72335 |
Second Address | Forrest City, AR 72335 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 28/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
123626608 | (05) | AR |
59632 | BCBS PROVIDER # (01) | AR |
710851189 | TAX IDENTIFICATION NUMBER (01) | AR |
862131 | UNITED CONCORDIA NUMBER (01) | AR |