NPIMap

Organization Active NPI

Arkansas Dental Professionals, Mongrain, P.a

Doing business as Arkadelphia Dental Care

  • Dentist
  • Arkadelphia, AR
National Provider Identifier
1740435312
Registry record updated May 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2256 Issued in AR
Legal business name
ARKANSAS DENTAL PROFESSIONALS, MONGRAIN, P.A
Doing business as
Arkadelphia Dental Care
Practice address
3003 Twin Rivers Dr
Arkadelphia, AR 71923-4219
Phone
(870) 246-2242
Fax
(870) 246-2495
NPI assigned
Nov 24, 2008
Last updated
May 10, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2019

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

Authorized official

Name
Hannah Fish
Title
Credentialing Coordinator
Phone
(217) 540-5699

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2256 AR Primary

Addresses

Primary practice location

3003 Twin Rivers Dr
Arkadelphia, AR 71923-4219

Mailing address

3003 Twin Rivers Dr
Arkadelphia, AR 71923-4219
Phone (870) 246-2242

Other identifiers 1

IdentifierTypeStateIssuer
172175631MedicaidAR

Other names 1

  • Arkadelphia Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Arkansas Dental Professionals Mongrain PA7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

3003 Twin Rivers Dr
Arkadelphia, AR 71923
Phone (870) 246-2242

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": "1227484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557446400000",
    "number": "1740435312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3003 TWIN RIVERS DR",
            "city": "ARKADELPHIA",
            "state": "AR",
            "postal_code": "719234219",
            "telephone_number": "870-246-2242",
            "fax_number": "870-246-2495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3003 TWIN RIVERS DR",
            "city": "ARKADELPHIA",
            "state": "AR",
            "postal_code": "719234219",
            "telephone_number": "870-246-2242",
            "fax_number": "870-246-2495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARKANSAS DENTAL PROFESSIONALS, MONGRAIN, P.A",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-24",
        "last_updated": "2019-05-10",
        "status": "A",
        "authorized_official_last_name": "FISH",
        "authorized_official_first_name": "HANNAH",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-5699"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AR",
            "license": "2256",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "172175631",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arkadelphia Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Arkadelphia, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2019; 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.