Active NPI
John Watson Buntin, DDS
- Dentist
- West Memphis, AR
National Provider Identifier
1750433686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2346
- Practice address
- 312 Missouri St
West Memphis, AR 72301 - Phone
- (870) 735-1673
- Fax
- (870) 735-2847
- NPI assigned
- Jan 18, 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 2346 | AR | Primary |
Addresses
Primary practice location
312 Missouri St
West Memphis, AR 72301
Mailing address
PO Box 188
West Memphis, AR 72303
Phone (870) 735-1673
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0184611 | Other | TN | BLUE CROSS BLUE SHIELD |
| 156643 | Other | UNITED CONCORDIA | |
| 58956 | Other | AR | BLUE CROSS BLUE SHIELD |
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 |
|---|---|---|---|
| 2346 | AR | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1750433686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 188",
"city": "WEST MEMPHIS",
"state": "AR",
"postal_code": "72303",
"telephone_number": "870-735-1673",
"fax_number": "870-735-2847"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "312 MISSOURI ST",
"city": "WEST MEMPHIS",
"state": "AR",
"postal_code": "72301",
"telephone_number": "870-735-1673",
"fax_number": "870-735-2847"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUNTIN",
"first_name": "JOHN",
"middle_name": "WATSON",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AR",
"license": "2346",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0184611",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "156643",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "58956",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Memphis, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.