Active NPI
James Alfred Summitt, DDS
- General Practice Dentistry
- Conway, AR
National Provider Identifier
1750410569
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2269
- Practice address
- 830 N Creek Dr
Conway, AR 72032-4711 - Phone
- (501) 932-0559
- Fax
- (501) 932-0227
- NPI assigned
- Mar 5, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2269 | AR | Primary |
Addresses
Primary practice location
830 N Creek Dr
Conway, AR 72032-4711
Mailing address
1770 Angeline Dr
Conway, AR 72032-8601
Phone (501) 336-8863
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 112154608 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2269 | AR | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1750410569",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1770 ANGELINE DR",
"city": "CONWAY",
"state": "AR",
"postal_code": "720328601",
"telephone_number": "501-336-8863",
"fax_number": "501-932-0227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "830 N CREEK DR",
"city": "CONWAY",
"state": "AR",
"postal_code": "720324711",
"telephone_number": "501-932-0559",
"fax_number": "501-932-0227"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUMMITT",
"first_name": "JAMES",
"middle_name": "ALFRED",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-05",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AR",
"license": "2269",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "112154608",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Conway, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.