NPIMap

Organization Active NPI

Ozark Pediatric Dentistry

  • Pediatric Dentistry
  • Siloam Springs, AR
National Provider Identifier
1831621309
Registry record updated Apr 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
3817 Issued in AR
Legal business name
OZARK PEDIATRIC DENTISTRY
Practice address
2125 E Main St
Suite #13
Siloam Springs, AR 72761-5571
Phone
(479) 886-0591
NPI assigned
Apr 3, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2017

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

Authorized official

Name
Matthew S Killingsworth, DMDNPI 1871887422
Title
Owner
Phone
(479) 886-0591

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 3817 AR Primary

Addresses

Primary practice location

2125 E Main St
Suite #13
Siloam Springs, AR 72761-5571

Mailing address

2125 E Main St
Suite #13
Siloam Springs, AR 72761-5571
Phone (479) 886-0591

National Provider Directory

National Provider Directory

Locations

2125 E Main St
Ste 13
Siloam Springs, AR 72761
Phone (479) 231-3005

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1491177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491177600000",
    "number": "1831621309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2125 E MAIN ST",
            "address_2": "SUITE #13",
            "city": "SILOAM SPRINGS",
            "state": "AR",
            "postal_code": "727615571",
            "telephone_number": "479-886-0591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2125 E MAIN ST",
            "address_2": "SUITE #13",
            "city": "SILOAM SPRINGS",
            "state": "AR",
            "postal_code": "727615571",
            "telephone_number": "479-886-0591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OZARK PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-03",
        "last_updated": "2017-04-03",
        "status": "A",
        "authorized_official_last_name": "KILLINGSWORTH",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-886-0591",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AR",
            "license": "3817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Siloam Springs, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2017; 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.