NPIMap

Organization Active NPI

Arkansas Dental Professionals, Mongrain, P.a.

  • General Practice Dentistry
  • Little Rock, AR
National Provider Identifier
1548675606
Registry record updated Jun 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
ARKANSAS DENTAL PROFESSIONALS, MONGRAIN, P.A.
Practice address
3801 Woodland Heights Rd Ste 175
Little Rock, AR 72212-2481
Phone
(501) 224-1004
NPI assigned
Jun 27, 2014
Organization subpart
Yes
Parent organization
ARKANSAS DENTAL PROFESSIONALS, MONGRAIN, P.A.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 27, 2014

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

Authorized official

Name
Kim Wilson
Title
Cred Supervisor
Phone
(217) 540-5170

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

3801 Woodland Heights Rd Ste 175
Little Rock, AR 72212-2481

Mailing address

3801 Woodland Heights Rd Ste 175
Little Rock, AR 72212-2481

Other names 1

  • Woodland Heights family Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Arkansas Dental Professionals Mongrain PA7 organizations share this tax ID, including this one
Part of
Arkansas Dental Professionals Mongrain PA

Other organizations with this tax ID 6

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

Locations

3801 Woodland Heights Rd
Ste 175
Little Rock, AR 72212
Phone (501) 224-1004

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1403827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403827200000",
    "number": "1548675606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 WOODLAND HEIGHTS RD STE 175",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722122481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 WOODLAND HEIGHTS RD STE 175",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722122481",
            "telephone_number": "501-224-1004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARKANSAS DENTAL PROFESSIONALS, MONGRAIN, P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ARKANSAS DENTAL PROFESSIONALS, MONGRAIN, P.A.",
        "enumeration_date": "2014-06-27",
        "last_updated": "2014-06-27",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "CRED SUPERVISOR",
        "authorized_official_telephone_number": "217-540-5170"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Woodland Heights family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2014; 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.