NPIMap

Organization Active NPI

Ford Dental Care

  • General Practice Dentistry
  • Gentry, AR
National Provider Identifier
1124182142
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3095 Issued in AR
Legal business name
FORD DENTAL CARE
Practice address
125 N Rust Ave
Gentry, AR 72734
Phone
(479) 736-8789
Fax
(479) 736-5011
NPI assigned
Dec 21, 2006
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. Jerry Derek Ford, DDSNPI 1487646022
Title
President
Phone
(479) 464-9669

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 3095 AR Primary

Addresses

Primary practice location

125 N Rust Ave
Gentry, AR 72734

Mailing address

125 N Rust Ave
Gentry, AR 72734
Phone (479) 736-8789

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124182142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 N RUST AVE",
            "city": "GENTRY",
            "state": "AR",
            "postal_code": "72734",
            "telephone_number": "479-736-8789",
            "fax_number": "479-736-5011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 N RUST AVE",
            "city": "GENTRY",
            "state": "AR",
            "postal_code": "72734",
            "telephone_number": "479-736-8789",
            "fax_number": "479-736-5011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORD DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "DEREK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "479-464-9669",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "3095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gentry, 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.