Provider Demographics
NPI:1699951996
Name:GOLDTRAP, ROBERT C (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:GOLDTRAP
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 1:4001 W FINANCIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1449
Mailing Address - Country:US
Mailing Address - Phone:479-636-8700
Mailing Address - Fax:
Practice Address - Street 1:4001 W FINANCIAL PKWY
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1449
Practice Address - Country:US
Practice Address - Phone:479-636-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3242122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U751OtherBLUE CROSS BLUE SHIELD
OK200108090AMedicaid
AR139699608Medicaid
AR710861858Medicaid
464681OtherUNITED CONCORDIA