AXPM JONESBORO PEDO, PLLC (NPI# 1861937518) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861937518 |
| Entity Type | Organization |
| Organization Name | AXPM JONESBORO PEDO, PLLC |
| Other Organization Name | LEAP KIDS DENTAL- JONESBORO |
| Practice Address |
1150 E Matthews Ave Ste 102 Jonesboro AR 72401-4346 |
| Mailing Address |
Po Box 3450 Little Rock AR 72203-3450 |
| Practice Telephone | 8709315437 |
| Mailing Telephone | 5017812777 |
| Enumeration Date | 2017-01-04 |
| Last Update Date | 2017-01-04 |
| Authorized Official Name | MARK DAKE (OWNER) |
| Authorized Official Telephone | 5017812777 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
AR | Dental Providers |
| Other Name | Type Code |
|---|---|
| Leap Kids Dental- Jonesboro | Doing Business As Name - Organization |
| Street Address |
1150 E MATTHEWS AVE STE 102 |
| City | JONESBORO |
| State | AR |
| Zip Code | 72401-4346 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134121635 | Pediatric Associates of Jonesboro, Pllc | Pediatrics | 1150 E Matthews Ave, Suite 101, Jonesboro, AR 72401-4314 | 2005-08-15 |
| 1518356013 | Tomorrow Atkins Potter | Nurse Practitioner | 1150 E Matthews Ave, Ste 101, Jonesboro, AR 72401-4346 | 2015-01-21 |
| 1649512146 | Maryjoanne Chinyem Umeora | Pediatrics | 1150 E Matthews Ave, Ste 101, Jonesboro, AR 72401-4346 | 2013-03-22 |
| 1295065852 | Jonesboro Plastic Surgery Associates Inc | Plastic Surgery | 1150 E Matthews Ave, Ste 201, Jonesboro, AR 72401-4346 | 2010-01-05 |
| 1912032657 | Arkansas Urology Clinic, Ltd | Urology | 1150 E Matthews Ave, Suite 203, Jonesboro, AR 72401-4314 | 2007-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407453368 | Mariah Kay Jackson | Physical Therapy Assistant | Creative Kids Therapy, Jonesboro, AR 72401 | 2020-10-05 |
| 1821606005 | Kafayat Folake Iyanda | Specialist/Technologist | 2105 East Aggie Rd, Jonesboro, AR 72401 | 2020-07-14 |
| 1053936310 | Josh Roberts | Physical Therapist | 1010 South Main St, Jonesboro, AR 72401 | 2020-06-12 |
| 1003449687 | Amy Mary Elizabeth Daughhetee | Nurse Practitioner | 225 East Washington Ave, Jonesboro, AR 72401 | 2020-02-21 |
| 1871126698 | Sarah Lowtharp | Clinical Nurse Specialist | 225 East Washington Ave., Jonesboro, AR 72401 | 2020-02-20 |
| 1891335519 | Mallori Miller | Case Manager/Care Coordinator | 837 Willett Rd, Jonesboro, AR 72401 | 2020-01-10 |
| 1265073704 | Michael Bruce Collie | Registered Nurse | 837 Williett Road, Jonesboro, AR 72401 | 2019-10-07 |
| 1285283432 | Jonesboro Ambulatory Surgery Center, LLC | Clinic/Center | 1710 Mayfield Dr, Jonesboro, AR 72401 | 2019-09-10 |
| 1841843943 | Destinee Katrina Cole | Specialist/Technologist | 2015 Aggie Rd, Jonesboro, AR 72401 | 2019-07-18 |
| 1699250472 | Jessica Marie Mcnatt | Occupational Therapist | 907 County Road 753, Jonesboro, AR 72401 | 2018-09-27 |
| Find all providers in zip 72401 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720242167 | Summer Barker Tyson | Dentist | 620 Southwest Dr, Jonesboro, AR 72401-5859 | 2008-07-15 |
| 1790909752 | Ken Wood, D.d.s. M.s. Childrens Dentistry | Dentist | 2702 S Culberhouse St, Suite Q, Jonesboro, AR 72401-7132 | 2007-04-12 |
| 1447310883 | Michael Douglas Oliver Jr. | Dentist | 809 Windover Rd, Jonesboro, AR 72401-6010 | 2006-12-08 |
| 1548360001 | Ken I Wood | Dentist | 2702 Culberhouse, Southwest Village, Jonesboro, AR 72401 | 2006-09-25 |
| 1164411674 | Dentistry for Children | Dentist | 435 Arrowhead Blvd, Jonesboro, GA 30236-1219 | 2005-10-18 |
| 1225402373 | Homegrown Pediatric Dentistry and Orthodontics | Dentist | 405 Arrowhead Blvd, Jonesboro, GA 30236-1254 | 2015-11-30 |
| 1801181672 | Clemmisa Louise Harris | Dentist | 809 Windover Rd, Jonesboro, AR 72401-6010 | 2011-06-09 |
| 1538453006 | Tyson Dental Associates Pllc | Dentist | 620 Southwest Dr, Jonesboro, AR 72401-5859 | 2011-06-02 |
| 1689791519 | Angel M Guardiola | Dentist | 405 Arrowhead Blvd, Jonesboro, GA 30236-1254 | 2007-03-24 |
| 1902829161 | Brad Warren Roehl | Dentist | 435 Arrowhead Blvd, Jonesboro, GA 30236-1219 | 2006-07-26 |
| Find all providers in JONESBORO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.