Northwest Arkansas Pediatric Dental Center

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

2924 Issued in AR

Legal business name

NORTHWEST ARKANSAS PEDIATRIC DENTAL CENTER

Doing business as

Smile Shoppe Pediatric Dentistry

Practice address

5518 Walsh LN
Rogers, AR 72758-8947

Phone

(479) 631-6377

Fax

(479) 273-5967

NPI assigned

Jun 22, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Jeffrey D Rhodes

Title

President

Phone

(479) 631-6377

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Smile Shoppe Pediatric Dentistry Doing business as

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453161600000",
    "number": "1033155411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5518 WALSH LN",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727588947",
            "telephone_number": "479-631-6377",
            "fax_number": "479-273-5967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5518 WALSH LN",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727588947",
            "telephone_number": "479-631-6377",
            "fax_number": "479-273-5967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST ARKANSAS PEDIATRIC DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-22",
        "last_updated": "2016-01-19",
        "status": "A",
        "authorized_official_last_name": "RHODES",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "479-631-6377",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AR",
            "license": "2924",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "159561631",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smile Shoppe Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pediatric Dentistry in Rogers, AR
• Providers in Rogers, AR by specialty
• Pediatric Dentistry in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2016; 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.