Bernard W Petkovich, DDS PA

Primary specialty

DentistTaxonomy code 122300000X

License

2371 Issued in AR

Practice address

500 Hospital Dr
Mountain Home, AR 72653-2913

Phone

(870) 425-9757

Fax

(870) 424-9056

NPI assigned

Aug 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• B.W. Petkovich, D.D.S., PA

  • General Practice Dentistry
  • Mountain Home, AR
  • NPI 1417268426
  NPD (past) Authorized official
• Axpm-Mountain Home Dental

  • General Practice Dentistry
  • Mountain Home, AR
  • NPI 1124563895
  NPD (past)

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368662400000",
    "number": "1336253582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 HOSPITAL DR",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726532913",
            "telephone_number": "870-425-9757",
            "fax_number": "870-424-9056"
        },
        {
            "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",
            "fax_number": "870-424-9056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETKOVICH",
        "first_name": "BERNARD",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "credential": "DDS PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2013-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AR",
            "license": "2371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennfier Pepin, RN
• Blake Pepper, PTA
• Perry L Wilbur MD PA
• Personal Therapy Group, LLC
• Kimberly Sue Peters, NP-C
• Daniel Pevril
• Physical Therapy Connection, Inc.
• Physical Therapy Specialists of the Ozarks, LLC (Ozark Physical Therapy Specialists)
• Physician Management Services of Arkansas II LLC
• Physician Management Services of Arkansas, LLC

• Dentist in Mountain Home, AR
• Providers in Mountain Home, AR by specialty
• Dentist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.