NPIMap

Organization Active NPI

Ut Pediatric Dentistry

  • Pediatric Dentistry
  • West Memphis, AR
National Provider Identifier
1407988116
Registry record updated Mar 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
UT PEDIATRIC DENTISTRY
Practice address
200 W Tyler Ave
West Memphis, AR 72301-4223
Phone
(870) 733-3854
Fax
(870) 733-3851
NPI assigned
Mar 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2009

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

Authorized official

Name
Dr. Sanford Jay Fenton, D.D.S.
Title
Chair
Phone
(870) 733-3854

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

200 W Tyler Ave
West Memphis, AR 72301-4223

Mailing address

200 W Tyler Ave
West Memphis, AR 72301-4223
Phone (870) 733-3854

Other identifiers 3

IdentifierTypeStateIssuer
150226608MedicaidAR
107199608MedicaidAR
111494608MedicaidAR

National Provider Directory

National Provider Directory
Tax ID family
Ut CT HLTH SC Fam Prac CT26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

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

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237420800000",
    "number": "1407988116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W TYLER AVE",
            "city": "WEST MEMPHIS",
            "state": "AR",
            "postal_code": "723014223",
            "telephone_number": "870-733-3854",
            "fax_number": "870-733-3851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W TYLER AVE",
            "city": "WEST MEMPHIS",
            "state": "AR",
            "postal_code": "723014223",
            "telephone_number": "870-733-3854",
            "fax_number": "870-733-3851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UT PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2009-03-19",
        "status": "A",
        "authorized_official_last_name": "FENTON",
        "authorized_official_first_name": "SANFORD",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "CHAIR",
        "authorized_official_telephone_number": "870-733-3854",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150226608",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107199608",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111494608",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Memphis, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2009; 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.