1477780302 NPI number — DR. JOHN T. AHRENS D.M.D. PA

Table of content: (NPI 1477780302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477780302 NPI number — DR. JOHN T. AHRENS D.M.D. PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. JOHN T. AHRENS D.M.D. PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477780302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
403 E 7TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAIN HOME
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72653-3948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
870-425-1504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
403 E 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN HOME
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72653-3948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-425-3730
Provider Business Practice Location Address Fax Number:
870-425-1504
Provider Enumeration Date:
06/18/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AHRENS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
870-425-3730

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 58015 . This is a "ARKANSAS BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 868720 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".