NPIMap

Organization Active NPI

Puckett Dental LLC

  • Dentist
  • Paragould, AR
National Provider Identifier
1669608741
Registry record updated Mar 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
3406 Issued in AR
Legal business name
PUCKETT DENTAL LLC
Practice address
624 W Court St
Suite a
Paragould, AR 72450-4247
Phone
(870) 236-5888
Fax
(870) 236-6888
NPI assigned
Jun 3, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2015

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

Authorized official

Name
Dr. John Hartley Puckett, D.D.S.NPI 1013993492
Title
Owner
Phone
(870) 236-5888

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 3406 AR Primary

Addresses

Primary practice location

624 W Court St
Suite a
Paragould, AR 72450-4247

Mailing address

PO Box 1209
Paragould, AR 72451-1209
Phone (870) 236-5888

Other identifiers 1

IdentifierTypeStateIssuer
176117631MedicaidAR

Other names 1

  • Ridge Kids Dental Doing business as

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 2

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": "1243987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426550400000",
    "number": "1669608741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1209",
            "city": "PARAGOULD",
            "state": "AR",
            "postal_code": "724511209",
            "telephone_number": "870-236-5888",
            "fax_number": "870-236-6888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 W COURT ST",
            "address_2": "SUITE A",
            "city": "PARAGOULD",
            "state": "AR",
            "postal_code": "724504247",
            "telephone_number": "870-236-5888",
            "fax_number": "870-236-6888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUCKETT DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-03",
        "last_updated": "2015-03-17",
        "status": "A",
        "authorized_official_last_name": "PUCKETT",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "HARTLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "870-236-5888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "AR",
            "license": "3406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "176117631",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ridge Kids Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Paragould, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2015; 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.