NPIMap

Organization Active NPI

Oral Surgery of Central Arkansas

  • Oral and Maxillofacial Surgery Clinic/Center
  • North Little Rock, AR
National Provider Identifier
1124491733
Registry record updated Nov 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X
License
3775 Issued in AR
Legal business name
ORAL SURGERY OF CENTRAL ARKANSAS
Practice address
2504 McCain Blvd Ste 202
North Little Rock, AR 72116-7612
Phone
(501) 771-7600
NPI assigned
Nov 4, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2015

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

Authorized official

Name
Dr. John M Johnson, DDSNPI 1699094714
Title
President
Phone
(501) 327-5255

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery Clinic/Center 261QS0112X 3775 AR Primary
Oral and Maxillofacial Surgery Clinic/Center 261QS0112X 2606 AR

Addresses

Primary practice location

2504 McCain Blvd Ste 202
North Little Rock, AR 72116-7612

Mailing address

2504 McCain Blvd Ste 202
North Little Rock, AR 72116-7612

Other identifiers 2

IdentifierTypeStateIssuer
200352679MedicaidAR
202575679MedicaidAR

National Provider Directory

National Provider Directory
Tax ID family
Oral Surgery of Central Arkansas2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

2504 McCain Blvd
Ste 202
North Little Rock, AR 72116
Phone (501) 771-7600

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": "1446595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446595200000",
    "number": "1124491733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2504 MCCAIN BLVD STE 202",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721167612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2504 MCCAIN BLVD STE 202",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721167612",
            "telephone_number": "501-771-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORAL SURGERY OF CENTRAL ARKANSAS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-04",
        "last_updated": "2015-11-04",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "501-327-5255",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "AR",
            "license": "3775",
            "primary": true
        },
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "AR",
            "license": "2606",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200352679",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202575679",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2015; 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.