NPIMap

Organization Active NPI

Arkansas Dental Clinic

  • General Practice Dentistry
  • Jonesboro, AR
National Provider Identifier
1558538181
Registry record updated Jun 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2621 Issued in AR
Legal business name
ARKANSAS DENTAL CLINIC
Practice address
3409 Gateway Cove
Jonesboro, AR 72404
Phone
(870) 336-0543
NPI assigned
May 13, 2008
Last updated
Jun 10, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2008

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

Authorized official

Name
Mrs. Diane Secrease, RDA CDA
Title
Office Manager
Phone
(870) 932-0330

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2621 AR Primary

Addresses

Primary practice location

3409 Gateway Cove
Jonesboro, AR 72404

Mailing address

3409 Gateway Cove
Jonesboro, AR 72404
Phone (870) 336-0543

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1210636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213056000000",
    "number": "1558538181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3409 GATEWAY COVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "72404",
            "telephone_number": "870-336-0543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3409 GATEWAY COVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "72404",
            "telephone_number": "870-336-0543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARKANSAS DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-13",
        "last_updated": "2008-06-10",
        "status": "A",
        "authorized_official_last_name": "SECREASE",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "870-932-0330",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RDA CDA"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "2621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2008; 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.