Arkansas Dental Professionals, Mongrain, P.a.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3370 Issued in AR

Legal business name

ARKANSAS DENTAL PROFESSIONALS, MONGRAIN, P.A.

Doing business as

Van Buren Family Dentistry

Practice address

635 Fayetteville Rd
Van Buren, AR 72956-3418

Phone

(479) 474-9696

NPI assigned

Dec 5, 2006

Organization subpart

No

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

Authorized official

Name

Hillary Thull

Title

Credentialing Coordinator

Phone

(217) 540-8946

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Van Buren Family Dentistry Doing business as

Tax ID family

Arkansas Dental Professionals Mongrain PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Philip S. Morton Family Dentistry, PLLC

  • Dentist
  • Cedarville, AR
  • NPI 1871917625
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Connor Catron, DDS

  • Dentist
  • Van Buren, AR
  • NPI 1265327407
  NPD (past)
• Philip Morton, D.D.S.

  • General Practice Dentistry
  • Van Buren, AR
  • NPI 1831257245
  NPD (past)

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759881600000",
    "number": "1396803722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 FAYETTEVILLE RD",
            "city": "VAN BUREN",
            "state": "AR",
            "postal_code": "729563418",
            "telephone_number": "479-474-9696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 FAYETTEVILLE RD",
            "city": "VAN BUREN",
            "state": "AR",
            "postal_code": "729563418",
            "telephone_number": "479-474-9696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARKANSAS DENTAL PROFESSIONALS, MONGRAIN, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2025-10-08",
        "certification_date": "2025-10-08",
        "status": "A",
        "authorized_official_last_name": "THULL",
        "authorized_official_first_name": "HILLARY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-8946"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "3370",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "161559608",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Van Buren Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Van Buren, AR
• Providers in Van Buren, AR by specialty
• General Practice Dentistry in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2025; 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.