Provider Demographics
NPI:1427146364
Name:COLCLASURE, DALE E SR (DDS)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:E
Last Name:COLCLASURE
Suffix:SR
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 1:32 RIVER ESTATES COVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72112
Mailing Address - Country:US
Mailing Address - Phone:501-868-5966
Mailing Address - Fax:
Practice Address - Street 1:2501 CRESTWOOD
Practice Address - Street 2:STE 103
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116
Practice Address - Country:US
Practice Address - Phone:501-758-3393
Practice Address - Fax:501-758-4346
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2111122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58089OtherBLUE CROSS BLUE SHIELD
AR801533OtherUNITED CONCORDIA