Organization Active NPI

Ar Dental & TMJ - Little Rock, LLC

  • General Practice Dentistry
  • Little Rock, AR
National Provider Identifier
1780985978
Registry record updated Mar 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
AR DENTAL & TMJ - LITTLE ROCK, LLC
Practice address
12018 Chenal Pkwy
Little Rock, AR 72211-2759
Phone
(501) 225-1577
Fax
(501) 219-4780
NPI assigned
Nov 4, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2012

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

Authorized official

Name
Miss Erin Cupan
Title
Practice Administrator
Phone
(501) 225-1577

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 2268 AR
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X AR Primary
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X 3966 AR

Addresses

Primary practice location

12018 Chenal Pkwy
Little Rock, AR 72211-2759

Mailing address

12018 Chenal Pkwy
Little Rock, AR 72211-2759
Phone (501) 225-1577

Other identifiers 1

IdentifierTypeStateIssuer
180256679MedicaidAR

National Provider Directory

National Provider Directory
Tax ID family
Ar Dental TMJ - Little Rock LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1288828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332288000000",
    "number": "1780985978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12018 CHENAL PKWY",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722112759",
            "telephone_number": "501-225-1577",
            "fax_number": "501-219-4780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12018 CHENAL PKWY",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722112759",
            "telephone_number": "501-225-1577",
            "fax_number": "501-219-4780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AR DENTAL & TMJ - LITTLE ROCK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-04",
        "last_updated": "2012-03-21",
        "status": "A",
        "authorized_official_last_name": "CUPAN",
        "authorized_official_first_name": "ERIN",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "501-225-1577",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "2268",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": null,
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AR",
            "license": "3966",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "180256679",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2012; 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.