Active NPI
Jerry Derek Ford, DDS
- General Practice Dentistry
- Gentry, AR
National Provider Identifier
1487646022
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 3095
- Practice address
- 125 North Rust Ave
Gentry, AR 72734 - Phone
- (479) 736-8789
- Fax
- (479) 736-5011
- NPI assigned
- Aug 19, 2005
- Reactivated
- Apr 10, 2006
- Sex
- Male
- Sole proprietor
- No
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 | 3095 | AR | Primary |
Addresses
Primary practice location
125 North Rust Ave
Gentry, AR 72734
Mailing address
PO Box 1290
Gentry, AR 72734-1290
Phone (479) 736-8789
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3095 | AR | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ford Dental Care | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Gentry, AR
- NPI 1124182142
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1487646022",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1290",
"city": "GENTRY",
"state": "AR",
"postal_code": "727341290",
"telephone_number": "479-736-8789",
"fax_number": "479-736-5011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 NORTH RUST AVE",
"city": "GENTRY",
"state": "AR",
"postal_code": "72734",
"telephone_number": "479-736-8789",
"fax_number": "479-736-5011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORD",
"first_name": "JERRY",
"middle_name": "DEREK",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-19",
"last_updated": "2007-07-08",
"deactivation_date": "2006-03-23",
"reactivation_date": "2006-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AR",
"license": "3095",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gentry, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.