NPIMap

Organization Active NPI

Washington Regional Medical Center

Doing business as Washington Regiona Medical Center Mobile Dental Clinic

  • Dentist
  • Fayetteville, AR
National Provider Identifier
1669877668
Registry record updated Nov 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
WASHINGTON REGIONAL MEDICAL CENTER
Doing business as
Washington Regiona Medical Center Mobile Dental Clinic
Practice address
12 E Appleby Rd
Suite 102
Fayetteville, AR 72703-3901
Phone
(479) 463-4746
Fax
(479) 463-7864
NPI assigned
Nov 3, 2014
Last updated
Nov 3, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2014

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

Authorized official

Name
William L Bradley
Title
Ceo
Phone
(469) 463-1000

Specialties & licenses 1

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

Addresses

Primary practice location

12 E Appleby Rd
Suite 102
Fayetteville, AR 72703-3901

Mailing address

12 E Appleby Rd
Suite 102
Fayetteville, AR 72703-3901
Phone (479) 463-4746

Other names 1

  • Washington Regiona Medical Center Mobile Dental Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Washington Regional Med Ctr5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

12 E Appleby Rd
Ste 102
Fayetteville, AR 72703
Phone (479) 463-4746

3264 N Northhills Blvd
Ste 100
Fayetteville, AR 72703

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1414972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414972800000",
    "number": "1669877668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 E APPLEBY RD",
            "address_2": "SUITE 102",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727033901",
            "telephone_number": "479-463-4746",
            "fax_number": "479-463-7864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 E APPLEBY RD",
            "address_2": "SUITE 102",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727033901",
            "telephone_number": "479-463-4746",
            "fax_number": "479-463-7864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHINGTON REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-03",
        "last_updated": "2014-11-03",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "469-463-1000"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Washington Regiona Medical Center Mobile Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Nov 3, 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.