Active NPI
Thomas Richard Bush, DDS
- Dentist
- Jacksonville, AR
National Provider Identifier
1487759569
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2007
- Practice address
- 200 N 2ND St
Jacksonville, AR 72076 - Phone
- (501) 982-9476
- Fax
- (501) 982-2621
- NPI assigned
- Sep 14, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 2007 | AR | Primary |
Addresses
Primary practice location
200 N 2ND St
Jacksonville, AR 72076
Mailing address
200 N 2ND St
Jacksonville, AR 72076
Phone (501) 982-9476
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 |
|---|---|---|---|
| 2007 | AR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1487759569",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 N 2ND ST",
"city": "JACKSONVILLE",
"state": "AR",
"postal_code": "72076",
"telephone_number": "501-982-9476",
"fax_number": "501-982-2621"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 N 2ND ST",
"city": "JACKSONVILLE",
"state": "AR",
"postal_code": "72076",
"telephone_number": "501-982-9476",
"fax_number": "501-982-2621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUSH",
"first_name": "THOMAS",
"middle_name": "RICHARD",
"name_prefix": "Mr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AR",
"license": "2007",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, 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.