NPIMap

Organization Active NPI

GKLM, PLLC

  • General Practice Dentistry
  • Fayetteville, AR
National Provider Identifier
1194226506
Registry record updated Aug 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
GKLM, PLLC
Practice address
1874 N Hunters RDG Ste 1
Fayetteville, AR 72701-2896
Phone
(479) 442-5092
Fax
(479) 587-0932
NPI assigned
Feb 22, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2021

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

Authorized official

Name
Dr. Grant Alan Davidson, DDSNPI 1164805511
Title
Dentist
Phone
(479) 442-5092

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 2439 AR
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1874 N Hunters RDG Ste 1
Fayetteville, AR 72701-2896

Mailing address

1874 N Hunters RDG Ste 1
Fayetteville, AR 72701-2896
Phone (479) 442-5092

Practitioners 2

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

National Provider Directory

National Provider Directory

Locations

1874 N Hunters Rdg
Ste 1
Fayetteville, AR 72701
Phone (479) 442-5092

NPI Registry JSON

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

{
    "created_epoch": "1519257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628035200000",
    "number": "1194226506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1874 N HUNTERS RDG STE 1",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727012896",
            "telephone_number": "479-442-5092",
            "fax_number": "479-587-0932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1874 N HUNTERS RDG STE 1",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727012896",
            "telephone_number": "479-442-5092",
            "fax_number": "479-587-0932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GKLM, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-22",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-03",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "GRANT",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "479-442-5092",
        "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": "2439",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2021; 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.