NPIMap

Organization Active NPI

Arkansas Dental Professionals, Mongrain, P.a

  • General Practice Dentistry
  • Little Rock, AR
National Provider Identifier
1114479136
Registry record updated Oct 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
ARKANSAS DENTAL PROFESSIONALS, MONGRAIN, P.A
Practice address
5500 W Markham St
Little Rock, AR 72205-3412
Phone
(501) 664-6888
NPI assigned
Oct 25, 2016
Organization subpart
Yes
Parent organization
ARKANSAS DENTAL PROFESSIONALS, MONGRAIN, P.AAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 25, 2016

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

Authorized official

Name
Cassandr Teutsch
Title
Credentialing Coordinator
Phone
(217) 540-8972

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

5500 W Markham St
Little Rock, AR 72205-3412

Mailing address

5500 W Markham St
Little Rock, AR 72205-3412
Phone (501) 664-6888

Other names 1

  • Markham Family Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Arkansas Dental Professionals Mongrain PA7 organizations share this tax ID, including this one
Part of
Arkansas Dental Professionals Mongrain PA

Other organizations with this tax ID 6

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

Locations

5500 W Markham St
Little Rock, AR 72205
Phone (501) 664-6888

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1477353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477353600000",
    "number": "1114479136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 W MARKHAM ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722053412",
            "telephone_number": "501-664-6888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 W MARKHAM ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722053412",
            "telephone_number": "501-664-6888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARKANSAS DENTAL PROFESSIONALS, MONGRAIN, P.A",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ARKANSAS DENTAL PROFESSIONALS, MONGRAIN, P.A",
        "enumeration_date": "2016-10-25",
        "last_updated": "2016-10-25",
        "status": "A",
        "authorized_official_last_name": "TEUTSCH",
        "authorized_official_first_name": "CASSANDR",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-8972"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Markham Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 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.