NORTHWEST ARKANSAS PERIODONTAL ASSOCIATES, PLLC (NPI# 1053418038) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1053418038 |
Entity Type | Organization |
Organization Name | NORTHWEST ARKANSAS PERIODONTAL ASSOCIATES, PLLC |
Practice Address |
1831 N Green Acres Rd Fayetteville AR 72703-2615 |
Practice Telephone | 4795216400 |
Practice Fax Number | 4795210164 |
Mailing Telephone | 4795216400 |
Mailing Fax Number | 4795210164 |
Enumeration Date | 2006-09-20 |
Last Update Date | 2020-08-22 |
Authorized Official Name | DR. GARY RENEGAR (MEMBER) |
Authorized Official Telephone | 4795216400 |
Authorized Official Credential | DDS |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 1223P0300X |
Dentist Specialization: Periodontics |
Dental Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
AR | BLUE CROSS BLUE SHIELD | 58605 | 01 |
Street Address |
1831 N GREEN ACRES RD |
City | FAYETTEVILLE |
State | AR |
Zip Code | 72703-2615 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1497852495 | Michael Curry | Dentist | 1831 N Green Acres Rd, Fayetteville, AR 72703-2615 | 2006-09-20 |
1407372949 | James M. Tinnin, D.d.s., M.s.d, P.a. | Dentist | 1831 N Green Acres Rd, Fayetteville, AR 72703-2615 | 2017-08-16 |
1528253416 | Northwest Arkansas Endodontic Specialists, Pa | Dentist | 1831 N Green Acres Rd, Fayetteville, AR 72703-2615 | 2007-09-13 |
1386764207 | James Martin Tinnin | Dentist | 1831 N Green Acres Rd, Fayetteville, AR 72703-2615 | 2007-04-02 |
1124149059 | James Charles Tinnin | Dentist | 1831 N Green Acres Rd, Fayetteville, AR 72703-2615 | 2007-04-02 |
1225135239 | Richard Pierce Osborne II | Dentist | 1831 N Green Acres Rd, Fayetteville, AR 72703-2615 | 2006-09-20 |
1326145350 | Gary Renegar | Dentist | 1831 N Green Acres Rd, Fayetteville, AR 72703-2615 | 2006-09-20 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1477154391 | Margaret Sorrells | Pharmacist | 3909 N Mall Ave Attn:pharmacy, Fayetteville, AR 72703 | 2020-11-06 |
1497369631 | Justin A Rand | Massage Therapist | 88 W Colt Square Dr, Fayetteville, Ar 72703, Fayetteville, AR 72703 | 2020-09-04 |
1235777558 | Washington Regional Medical System | Specialist | 3264 N North Hills Blvd, Fayetteville, AR 72703 | 2019-12-17 |
1760024582 | Haley Brooke Thompson | Occupational Therapist | 2474 E Joyce Blvd Ste 2, Null, Fayetteville, AR 72703 | 2019-10-14 |
1306492129 | Bhg L, LLC | Clinic/Center | 8 Colt Square Drive, Fayetteville, AR 72703 | 2019-08-16 |
1306406269 | Idell Marie Mitchell | Optometrist | Eye Clinic, 1100 N College Ave, Fayetteville, AR 72703 | 2019-06-13 |
1821574815 | Toni Myer | Nurse Practitioner | 3 E Appleby Rd Ste 101, Fayetteville, AR 72703 | 2018-07-13 |
1306340393 | Josh Kelfer | Student in an Organized Health Care Education/Training Program | 1125 North College Avenue, Fayetteville, AR 72703 | 2018-03-22 |
1649726449 | Vantage Point of Nwa | Community/Behavioral Health | 4171 N. Crossover Rd, Fayetteville, AR 72703 | 2016-08-31 |
1386097137 | Jason Nordstrom | Speech-Language Pathologist | 2664 N Valencia Ave, Fayetteville, AR 72703 | 2016-07-18 |
Find all providers in zip 72703 |
Taxonomy Code | 1223P0300X |
Grouping | Dental Providers |
Classification | Dentist |
Specialization | Periodontics |
That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
Notes: Source: Council on Dental Education and Licensure, American Dental Association |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1952650095 | Ping Seung Alice Wu | Dentist | 2029 Valleygate Dr Ste 201, Fayetteville, NC 28304-3772 | 2012-09-05 |
1235355017 | Myra Shivers | Dentist | 118 N Park Dr, Fayetteville, GA 30214-1645 | 2007-04-18 |
1417094392 | James M Vlassis | Dentist | 100 N Burdick St, Fayetteville, NY 13066-1319 | 2007-01-31 |
1497852495 | Michael Curry | Dentist | 1831 N Green Acres Rd, Fayetteville, AR 72703-2615 | 2006-09-20 |
1043584196 | Jeffrey A. Meltzer, D.m.d.,p.c. | Dentist | 516 E Genesee St, Fayetteville, NY 13066-1537 | 2012-03-06 |
1346468915 | William Wes Shelton | Dentist | 2001 N Green Acres Rd, Fayetteville, AR 72703-2619 | 2007-04-20 |
1447473947 | Ashish Kukreja | Dentist | 570 W Lanier Ave, Fayetteville, GA 30214-7649 | 2007-04-11 |
1780725465 | J. Michael Ruff, Dds, Pa | Dentist | 823 Elm St, Suite 220, Fayetteville, NC 28303-4172 | 2007-02-08 |
1346311800 | James Michael Ruff | Dentist | 823 Elm St, Suite 220, Fayetteville, NC 28303-4172 | 2006-11-13 |
1225135239 | Richard Pierce Osborne II | Dentist | 1831 N Green Acres Rd, Fayetteville, AR 72703-2615 | 2006-09-20 |
Find all providers in FAYETTEVILLE |
City | FAYETTEVILLE |
Zip Code | 72703 |
Please comment or provide details below to improve the information on NORTHWEST ARKANSAS PERIODONTAL ASSOCIATES, PLLC.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.