Axpm-Mountain Home Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

AXPM-MOUNTAIN HOME DENTAL

Practice address

500 Hospital Dr
Mountain Home, AR 72653-2913

Phone

(870) 425-9757

NPI assigned

Jan 4, 2017

Last updated

Jan 4, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mark Dake

Title

Owner

Phone

(501) 781-2777

Specialties & licenses 1

Addresses

Practitioners 2

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.

• Bernard W Petkovich, DDS PA

  • Dentist
  • Mountain Home, AR
  • NPI 1336253582
  NPD (past)
• Kimberly Petkovich Vaglio, D.D.S.

  • Dentist
  • Mountain Home, AR
  • NPI 1932429156
  NPD (past)

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

{
    "created_epoch": "1483488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483488000000",
    "number": "1124563895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3450",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722033450",
            "telephone_number": "501-781-2777",
            "fax_number": "501-781-2778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 HOSPITAL DR",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726532913",
            "telephone_number": "870-425-9757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AXPM-MOUNTAIN HOME DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-04",
        "last_updated": "2017-01-04",
        "status": "A",
        "authorized_official_last_name": "DAKE",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-781-2777"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Asag, Inc. (Ambulatory Surgery Anesthesia Group. Inc.)
• Ascent Acquisitions Corp-Cypdc (Child & Youth Pediatric Day Clinic)
• Aubrey Wilson Counseling, LLC
• Edward David Avants, PHARMD
• Kaytlin Avery, M.S., CF-SLP
• B.W. Petkovich, D.D.S., PA
• Gale E Bacan
• Abodunrin Sulaimon Olasubomi Badejo, M.D.
• Kelly Bahus
• Adam Bailey, PTA

• General Practice Dentistry in Mountain Home, AR
• Providers in Mountain Home, AR by specialty
• General Practice Dentistry in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2017; 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.