Healthcare Provider Details

I. General information

NPI: 1073620043
Provider Name (Legal Business Name): JAMES WESLEY BORENGASSER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAMES WESLEY BORENGASSER DDS

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 S 79TH ST STE 100
FORT SMITH AR
72903-6250
US

IV. Provider business mailing address

9205 ROSEWOOD DR
FORT SMITH AR
72903-7060
US

V. Phone/Fax

Practice location:
  • Phone: 479-242-3340
  • Fax:
Mailing address:
  • Phone: 479-242-3340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3525
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3525
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: