NORTHWEST ARKANSAS PERIODONTAL ASSOCIATES, PLLC


Address: 1831 N Green Acres Rd, Fayetteville, AR 72703-2615
Phone: 4795216400

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 1223P0300X Dentist
Specialization: Periodontics
Dental Providers

Other Provider Identifier

State Issuer Identifier Type Code
AR BLUE CROSS BLUE SHIELD 58605 01

Office Location

Street Address 1831 N GREEN ACRES RD
City FAYETTEVILLE
State AR
Zip Code 72703-2615

Providers in the same location

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

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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
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Taxonomy Information

Taxonomy Code 1223P0300X
Grouping Dental Providers
Classification Dentist
Specialization Periodontics

Taxonomy Definition

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

Providers in the same taxonomy and city

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
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Competitor

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City FAYETTEVILLE
Zip Code 72703

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Dataset Information

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.

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