Provider Demographics
NPI:1477780302
Name:DR. JOHN T. AHRENS D.M.D. PA
Entity Type:Organization
Organization Name:DR. JOHN T. AHRENS D.M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:AHRENS
Authorized Official - Suffix:
Authorized Official - Credentials:MDM
Authorized Official - Phone:870-425-3730
Mailing Address - Street 1:403 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3948
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:870-425-1504
Practice Address - Street 1:403 E 7TH ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3948
Practice Address - Country:US
Practice Address - Phone:870-425-3730
Practice Address - Fax:870-425-1504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58015OtherARKANSAS BLUE CROSS BLUE SHIELD
AR868720OtherUNITED CONCORDIA