NPIMap

Organization Active NPI

Arkansas Dental Health Professionals, Mongrain, P.a.

  • General Practice Dentistry
  • Bentonville, AR
National Provider Identifier
1891448155
Registry record updated Mar 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
ARKANSAS DENTAL HEALTH PROFESSIONALS, MONGRAIN, P.A.
Practice address
1101 NE McClain Rd
Bentonville, AR 72712-3833
Phone
(479) 333-1300
NPI assigned
Jan 27, 2022
Organization subpart
Yes
Parent organization
ARKANSAS DENTAL HEALTH PROFESSIONALS, MONGRAIN, P.A.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 10, 2025

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

Authorized official

Name
Hillary Thull
Title
Credentialing Coordinator
Phone
(217) 540-8946

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1101 NE McClain Rd
Bentonville, AR 72712-3833

Mailing address

1101 NE McClain Rd
Bentonville, AR 72712-3833

Other names 1

  • Integrated Dentistry 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
Part of
Arkansas Dental Health Professionals Mongrain PA

Other organizations with this tax ID 6

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

Locations

1101 NE McClain Rd
Bentonville, AR 72712
Phone (479) 333-1300

NPI Registry JSON

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

{
    "created_epoch": "1643241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741564800000",
    "number": "1891448155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 NE MCCLAIN RD",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727123833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 NE MCCLAIN RD",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727123833",
            "telephone_number": "479-333-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARKANSAS DENTAL HEALTH PROFESSIONALS, MONGRAIN, P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ARKANSAS DENTAL HEALTH PROFESSIONALS, MONGRAIN, P.A.",
        "enumeration_date": "2022-01-27",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A",
        "authorized_official_last_name": "THULL",
        "authorized_official_first_name": "HILLARY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-8946"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Integrated Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Integrated Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bentonville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2025; 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.