Provider Demographics
NPI:1073620043
Name:BORENGASSER, JAMES WESLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WESLEY
Last Name:BORENGASSER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:WESLEY
Other - Last Name:BORENGASSER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:9205 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-7060
Mailing Address - Country:US
Mailing Address - Phone:479-242-3340
Mailing Address - Fax:
Practice Address - Street 1:3510 S 79TH ST STE 100
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6250
Practice Address - Country:US
Practice Address - Phone:479-242-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR35251223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y464OtherBLUE CROSS BLUE SHIELD-AR