NPIMap

Organization Active NPI

Northwest Dental Associates

  • Dentist
  • Fayetteville, AR
National Provider Identifier
1669409918
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
3407 Issued in AR
Legal business name
NORTHWEST DENTAL ASSOCIATES
Practice address
2680 East Joyce Blvd
Fayetteville, AR 72703
Phone
(479) 521-0066
Fax
(479) 443-6542
NPI assigned
Jun 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Shelley R Wetzler
Title
Office Manager
Phone
(479) 521-0066

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 3407 AR Primary

Addresses

Primary practice location

2680 East Joyce Blvd
Fayetteville, AR 72703

Mailing address

2680 East Joyce Blvd
Fayetteville, AR 72703
Phone (479) 521-0066

National Provider Directory

National Provider Directory

Locations

2680 E Joyce Blvd
Fayetteville, AR 72703
Phone (479) 521-0004

Practitioners & affiliated clinicians

Practitioners 4

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": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1669409918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2680 EAST JOYCE BLVD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "72703",
            "telephone_number": "479-521-0066",
            "fax_number": "479-443-6542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2680 EAST JOYCE BLVD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "72703",
            "telephone_number": "479-521-0066",
            "fax_number": "479-443-6542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WETZLER",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "479-521-0066",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "AR",
            "license": "3407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.