Interdisciplinary Dental Therapy, P.a.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

AR3333 Issued in AR

Legal business name

INTERDISCIPLINARY DENTAL THERAPY, P.A.

Practice address

9200 Chicot Rd
Little Rock, AR 72209-6107

Phone

(501) 562-3029

Fax

(501) 568-1823

NPI assigned

Jan 6, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Montgomery Dwight Heathman, D.D.S.

Title

President/Ceo

Phone

(479) 856-5588

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1357430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357430400000",
    "number": "1992042386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9200 CHICOT RD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722096107",
            "telephone_number": "501-562-3029",
            "fax_number": "501-568-1823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9200 CHICOT RD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722096107",
            "telephone_number": "501-562-3029",
            "fax_number": "501-568-1823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERDISCIPLINARY DENTAL THERAPY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-06",
        "last_updated": "2013-01-06",
        "status": "A",
        "authorized_official_last_name": "HEATHMAN",
        "authorized_official_first_name": "MONTGOMERY",
        "authorized_official_middle_name": "DWIGHT",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "479-856-5588",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "AR3333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "161458608",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Little Rock, AR
• Providers in Little Rock, AR by specialty
• General Practice Dentistry in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2013; 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.