NPIMap

Organization Active NPI

Kristian C. Dietz, DDS, PLLC

Doing business as Bright Ridge Dental

  • General Practice Dentistry
  • Bentonville, AR
National Provider Identifier
1952723215
Registry record updated Jan 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3913 Issued in AR
Legal business name
KRISTIAN C. DIETZ, DDS, PLLC
Doing business as
Bright Ridge Dental
Practice address
1603 SW Regional Airport Blvd.
Bentonville, AR 72712
Phone
(479) 715-4277
NPI assigned
Jan 6, 2014
Last updated
Jan 6, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2014

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

Authorized official

Name
Dr. Kristian C Dietz, DDSNPI 1154550382
Title
Owner Dentist
Phone
(479) 715-4277

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
General Practice Dentistry 1223G0001X 3913 AR Primary

Addresses

Primary practice location

1603 SW Regional Airport Blvd.
Bentonville, AR 72712

Mailing address

1603 SW Regional Airport Blvd.
Bentonville, AR 72712
Phone (479) 715-4277

Other names 1

  • Bright Ridge Dental Doing business as

National Provider Directory

National Provider Directory

Locations

1603 SW Regional Airport Blvd
Bentonville, AR 72713
Phone (479) 339-0081

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1388966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388966400000",
    "number": "1952723215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1603 SW REGIONAL AIRPORT BLVD.",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "72712",
            "telephone_number": "479-715-4277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1603 SW REGIONAL AIRPORT BLVD.",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "72712",
            "telephone_number": "479-715-4277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KRISTIAN C. DIETZ, DDS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-06",
        "last_updated": "2014-01-06",
        "status": "A",
        "authorized_official_last_name": "DIETZ",
        "authorized_official_first_name": "KRISTIAN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "479-715-4277",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "3913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bright Ridge Dental",
            "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 Jan 6, 2014; 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.