Active NPI
Justin Bryce Bodeker, D.D.S.
- General Practice Dentistry
- Batesville, AR
National Provider Identifier
1386026417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4054
- Practice address
- 40 Mitchell Rd
Batesville, AR 72501 - Phone
- (870) 926-5102
- NPI assigned
- Jun 25, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4054 | AR | Primary |
Addresses
Primary practice location
40 Mitchell Rd
Batesville, AR 72501
Mailing address
PO Box 2451
Batesville, AR 72503-2451
Phone (870) 926-5102
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160115001120 | AR | Order and Referring Only - Oral Surgery | 1557664042 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1435190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571616000000",
"number": "1386026417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2451",
"city": "BATESVILLE",
"state": "AR",
"postal_code": "725032451",
"telephone_number": "870-926-5102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 MITCHELL RD",
"city": "BATESVILLE",
"state": "AR",
"postal_code": "72501",
"telephone_number": "870-926-5102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BODEKER",
"first_name": "JUSTIN",
"middle_name": "BRYCE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-06-25",
"last_updated": "2019-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AR",
"license": "4054",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Batesville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2019; 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.