NPIMap

Organization Active NPI

Maumelle Family Dentistry, PLLC

  • General Practice Dentistry
  • Maumelle, AR
National Provider Identifier
1154840593
Registry record updated Sep 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2244 Issued in AR
Legal business name
MAUMELLE FAMILY DENTISTRY, PLLC
Practice address
1701 Club Manor Dr Ste 4
Maumelle, AR 72113-7401
Phone
(501) 851-1414
NPI assigned
Sep 18, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2017

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

Authorized official

Name
Dr. Richard H Lewis, DDS
Title
Owner
Phone
(501) 851-1414

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 2244 AR Primary

Addresses

Primary practice location

1701 Club Manor Dr Ste 4
Maumelle, AR 72113-7401

Mailing address

1701 Club Manor Dr Ste 4
Maumelle, AR 72113-7401
Phone (501) 851-1414

Other identifiers 1

IdentifierTypeStateIssuer
104718608MedicaidAR

National Provider Directory

National Provider Directory

Locations

1701 Club Manor Dr
Ste 4
Maumelle, AR 72113
Phone (501) 851-1414

NPI Registry JSON

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

{
    "created_epoch": "1505692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505692800000",
    "number": "1154840593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 CLUB MANOR DR STE 4",
            "city": "MAUMELLE",
            "state": "AR",
            "postal_code": "721137401",
            "telephone_number": "501-851-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 CLUB MANOR DR STE 4",
            "city": "MAUMELLE",
            "state": "AR",
            "postal_code": "721137401",
            "telephone_number": "501-851-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAUMELLE FAMILY DENTISTRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-18",
        "last_updated": "2017-09-18",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-851-1414",
        "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": "2244",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104718608",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maumelle, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 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.