Ridge Dental Group PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

RIDGE DENTAL GROUP PLLC

Doing business as

Ridge Dental and Aesthetics

Practice address

808 Highway 64 E
Wynne, AR 72396-7414

Phone

(870) 238-2600

NPI assigned

Dec 21, 2021

Organization subpart

No

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

Authorized official

Name

Kelli Ellen Vanhouten- Grubbs

Title

Partner

Phone

(870) 238-2600

Specialties & licenses 1

Addresses

Other names 1

• Ridge Dental and Aesthetics Doing business as

Locations

Practitioners 1

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

• Kelli Ellen Grubbs, DDS

  • General Practice Dentistry
  • Arlington, TN
  • NPI 1508187626
  NPD

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

{
    "created_epoch": "1640044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640044800000",
    "number": "1972263739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 HIGHWAY 64 E",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723967414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 HIGHWAY 64 E",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723967414",
            "telephone_number": "870-238-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIDGE DENTAL GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-21",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A",
        "authorized_official_last_name": "VANHOUTEN- GRUBBS",
        "authorized_official_first_name": "KELLI",
        "authorized_official_middle_name": "ELLEN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "870-238-2600"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ridge Dental and Aesthetics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• David M Ray, LPC, NCC
• Joyce Mary Ray, LMSW
• Terry R. Reed, BOCPD
• Jodi Renigar, APRN, FNP-BC
• Ricky L Price DDS PA
• Marian P. Ritchie, SLP
• William Ritchie
• Lauren Rebecca Roach, PHARM D
• Patches L Robb, FNP-C
• Robert W Bassham DDS PA

• Dental Clinic/Center in Wynne, AR
• Providers in Wynne, AR by specialty
• Dental Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; 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.