Rodney Joe Roark, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3136 Issued in AR

Practice address

4102 N Mall Ave
Fayetteville, AR 72703-4911

Phone

(479) 442-2424

Fax

(479) 442-9325

NPI assigned

Jan 9, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407905698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4102 N MALL AVE",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034911",
            "telephone_number": "479-442-2424",
            "fax_number": "479-442-9325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4102 N MALL AVE",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034911",
            "telephone_number": "479-442-2424",
            "fax_number": "479-442-9325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROARK",
        "first_name": "RODNEY",
        "middle_name": "JOE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "3136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LISCENSE NUMBER",
            "identifier": "3136",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mandy Ritok
• Marbely Rivas
• Riverbend Therapies, LLC
• Renisha C Rivers
• Denise Trent Roark, PHARM D
• Roberds Chiropractic Clinic PLLC
• Savannah Lynn Roberson, MS, RD, LD
• Robert Baker MD Mha PLLC
• Robert Edward Martin
• Robert G Hodous DDS LTD

• General Practice Dentistry in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• General Practice Dentistry in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.