MEDICARE: DR. JAMES WESLEY BORENGASSER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3525	AR
2	122300000X	Dentist	3525	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5Y464	OTHER	AR	BLUE CROSS BLUE SHIELD-AR

General Provider Information

NPI Number	:	1073620043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES WESLEY BORENGASSER D.D.S.

Provider Business Mailing Address
First Line	:	9205 ROSEWOOD DR
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-7060
Country	:	US
Telephone Number	:	479-242-3340
Fax Number	:

Provider Business Practice Location Address
First Line	:	3510 S 79TH ST STE 100
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-6250
Country	:	US
Telephone Number	:	479-242-3340
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	03/17/2018

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Directions to “ DR. JAMES WESLEY BORENGASSER D.D.S.” Practice Location

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