Organization
NORTHWEST ARKANSAS PERIODONTAL ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY RENEGAR DDS (MEMBER)
(479) 521-6400
Entity
Organization
Contact information
Practice address
1831 N GREEN ACRES RD, FAYETTEVILLE, AR 72703-2615
(479) 521-6400
(479) 521-0164
Mailing address
1831 N GREEN ACRES RD, FAYETTEVILLE, AR 72703-2615
(479) 521-6400
(479) 521-0164
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58605
BLUE CROSS BLUE SHIELD
AR
Enumeration date
09/20/2006
Last updated
08/22/2020
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