NPIMap

Organization Active NPI

Northwest Arkansas Periodontal Associates, PLLC

  • Periodontics
  • Fayetteville, AR
National Provider Identifier
1053418038
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
NORTHWEST ARKANSAS PERIODONTAL ASSOCIATES, PLLC
Practice address
1831 N Green Acres Rd
Fayetteville, AR 72703-2615
Phone
(479) 521-6400
Fax
(479) 521-0164
NPI assigned
Sep 20, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Gary Renegar, DDSNPI 1326145350
Title
Member
Phone
(479) 521-6400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X Primary

Addresses

Primary practice location

1831 N Green Acres Rd
Fayetteville, AR 72703-2615

Mailing address

1831 N Green Acres Rd
Fayetteville, AR 72703-2615
Phone (479) 521-6400

Other identifiers 1

IdentifierTypeStateIssuer
58605OtherARBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory
Tax ID family
Northwest Arkansas Periodontal Associates PLLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1831 N Green Acres Rd
Fayetteville, AR 72703
Phone (479) 521-2814

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053418038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1831 N GREEN ACRES RD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727032615",
            "telephone_number": "479-521-6400",
            "fax_number": "479-521-0164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1831 N GREEN ACRES RD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727032615",
            "telephone_number": "479-521-6400",
            "fax_number": "479-521-0164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST ARKANSAS PERIODONTAL ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RENEGAR",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "479-521-6400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "58605",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.