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Contact Information

ARKANSAS DENTAL PROFESSIONALS, MONGRAIN, P.A.
635 FAYETTEVILLE RD
VAN BUREN, AR72956-3418
 Phone: 479-474-9696
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for ARKANSAS DENTAL PROFESSIONALS, MONGRAIN, P.A.

NPI # 1396803722
LBN Legal business name ARKANSAS DENTAL PROFESSIONALS, MONGRAIN, P.A.
Authorized official HILLARY THULL - (CREDENTIALING COORDINATOR)
Entity Organization
Organization subpart 1 No
Enumeration date 12/05/2006
Last updated 10/08/2025 - About 8 months ago
Identifiers
AR License # 3370
AR Medicaid 161559608
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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