Oral Surgery of Central Arkansas

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

ORAL SURGERY OF CENTRAL ARKANSAS

Practice address

4701 Fairway Ave Ste D
North Little Rock, AR 72116-8069

Phone

(501) 791-7600

Fax

(501) 791-2824

NPI assigned

Jan 15, 2021

Organization subpart

No

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

Authorized official

Name

Jennifer Patterson

Title

Office Manager

Phone

(013) 275-2555

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Richard Elimon,D.M.D. Doing business as
• Richard Elimon Former legal business name

Electronic endpoints 1

Locations

Practitioners 2

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

• Richard Gregory Elimon, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • North Little Rock, AR
  • NPI 1003903287
  NPD
• John M Johnson, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Conway, AR
  • NPI 1699094714
  NPD (past)

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

{
    "created_epoch": "1610668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610928000000",
    "number": "1245829027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4701 FAIRWAY AVE STE D",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721168069",
            "telephone_number": "501-327-5255",
            "fax_number": "501-791-2824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4701 FAIRWAY AVE STE D",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721168069",
            "telephone_number": "501-791-7600",
            "fax_number": "501-791-2824"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "707 Parkway St Ste 103",
            "address_purpose": "LOCATION",
            "city": "Conway",
            "state": "AR",
            "postal_code": "720345363",
            "country_code": "US",
            "telephone_number": "501-327-5255",
            "fax_number": "501-791-2824",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ORAL SURGERY OF CENTRAL ARKANSAS",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-15",
        "last_updated": "2021-01-18",
        "certification_date": "2021-01-18",
        "status": "A",
        "authorized_official_last_name": "PATTERSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "013-275-2555"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200352679",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@oralsurgeryofcentralarkansas.com",
            "affiliation": "N",
            "endpointDescription": "info@oralsurgeryofcentralarkansas.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "useOtherDescription": "North Little Rock",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "North Little Rock",
            "address_1": "4701 Fairway Ave Ste D",
            "city": "North Little Rock",
            "state": "AR",
            "country_code": "US",
            "postal_code": "721168069",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Richard Elimon,D.M.D.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Richard Elimon",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Zachary Benjamin Olivos, MD
• Leah Olson
• Omnis Rehab North Little Rock LLC
• James Paul Orahood, DDS
• Oral Surgery of Central Arkansas
• Aaliyah M Orloff
• Gray Matthew Orman, MD
• Nola Ornelas
• Orthoarkansas, PA
• Orthoarkansas, PA

• Oral and Maxillofacial Surgery (Dentist) in North Little Rock, AR
• Providers in North Little Rock, AR by specialty
• Oral and Maxillofacial Surgery (Dentist) in Arkansas

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