Childrens Dental Clinic of Jonesboro

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

CHILDRENS DENTAL CLINIC OF JONESBORO

Practice address

217 E Cherry Ave
Jonesboro, AR 72401-3372

Phone

(870) 897-2489

NPI assigned

Apr 4, 2019

Organization subpart

No

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

Authorized official

Name

Lauren Lee

Title

Office Manager

Phone

(870) 897-9465

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Misee Harris Kemp, D.M.D.

  • Pediatric Dentistry
  • Jonesboro, AR
  • NPI 1801181672
  NPD (past)
• Steven Andrew Robinson, D.D.S.

  • Pediatric Dentistry
  • Murfreesboro, TN
  • NPI 1972039220
  NPD (past)

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

{
    "created_epoch": "1554336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608595200000",
    "number": "1942762273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 E CHERRY AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 E CHERRY AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013372",
            "telephone_number": "870-897-2489"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "160 Greene 721 Rd Ste 3",
            "address_purpose": "LOCATION",
            "city": "Paragould",
            "state": "AR",
            "postal_code": "724508995",
            "country_code": "US",
            "telephone_number": "870-897-2489",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2007 E Nettleton Ave Ste C",
            "address_purpose": "LOCATION",
            "city": "Jonesboro",
            "state": "AR",
            "postal_code": "724015286",
            "country_code": "US",
            "telephone_number": "870-897-2439",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHILDRENS DENTAL CLINIC OF JONESBORO",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-04",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "870-897-9465"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023240595",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "clharris1@sbrmc.org",
            "affiliation": "Y",
            "endpointDescription": "Doc Halo",
            "affiliationName": "St Bernards Hospital Inc",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Secured Server",
            "address_1": "2007 E Nettleton Ave Ste C",
            "city": "Jonesboro",
            "state": "AR",
            "country_code": "US",
            "postal_code": "724015286",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Derek M Childers, MD
• Jacie Childers
• Melissa Ann Childers, APN
• Sara Destiny Page Childers, MHPP
• Childrens Dental Clinic of Jonesboro
• Childrens Learning Team
• Braylan Edward Childs
• Shravan Reddy Chintalapani, MD
• Brooke Chipman, SLP
• Chiro Care Inc

• Pediatric Dentistry in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Pediatric Dentistry in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2020; 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.