NPIMap

Organization Active NPI

Bold Dental Fort Smith West

  • General Practice Dentistry
  • Fort Smith, AR
National Provider Identifier
1669841946
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
BOLD DENTAL FORT SMITH WEST
Practice address
4208 Jenny Lind Rd
Fort Smith, AR 72901-7660
Phone
(479) 782-3400
NPI assigned
Sep 17, 2015
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
BOLD DENTAL PARTNERS, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Wendy Peduto
Title
Transition Manager
Phone
(501) 436-0518

Specialties & licenses 1

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

Addresses

Primary practice location

4208 Jenny Lind Rd
Fort Smith, AR 72901-7660

Mailing address

4208 Jenny Lind Rd
Fort Smith, AR 72901-7660
Phone (479) 782-3400

National Provider Directory

National Provider Directory
Tax ID family
Bold Dental Springdale6 organizations share this tax ID, including this one
Part of
Bold Dental Springdale

Other organizations with this tax ID 5

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

Locations

4208 Jenny Lind Rd
Fort Smith, AR 72901
Phone (479) 782-3400

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1442448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1669841946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4208 JENNY LIND RD",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729017660",
            "telephone_number": "479-782-3400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4208 JENNY LIND RD",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729017660",
            "telephone_number": "479-782-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLD DENTAL FORT SMITH WEST",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOLD DENTAL PARTNERS, PLLC",
        "enumeration_date": "2015-09-17",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PEDUTO",
        "authorized_official_first_name": "WENDY",
        "authorized_official_title_or_position": "TRANSITION MANAGER",
        "authorized_official_telephone_number": "501-436-0518"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Smith, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.