1437244589 NPI number — BOB MATHIS DDS PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437244589 NPI number — BOB MATHIS DDS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOB MATHIS DDS 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:
1437244589
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 GREEN VALLEY DR
Provider Second Line Business Mailing Address:
BOB MATHIS DDS PA
Provider Business Mailing Address City Name:
MOUNTAIN HOME
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72653-8102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-425-6911
Provider Business Mailing Address Fax Number:
870-424-4891

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 GREEN VALLEY DR
Provider Second Line Business Practice Location Address:
BOB MATHIS DDS PA
Provider Business Practice Location Address City Name:
MOUNTAIN HOME
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72653-8102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-425-6911
Provider Business Practice Location Address Fax Number:
870-424-4891
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MATHIS
Authorized Official First Name:
BOB
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT DENTIST
Authorized Official Telephone Number:
870-425-6911

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  2029 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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