MEDICARE: ARKANSAS DENTAL PROFESSIONALS, MONGRAIN, P.A.

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

General Provider Information

NPI Number	:	1083577803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARKANSAS DENTAL PROFESSIONALS, MONGRAIN, P.A.

Provider Business Mailing Address
First Line	:	4001 W FINANCIAL PKWY
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-1449
Country	:	US
Telephone Number	:	479-636-8700
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 W FINANCIAL PKWY
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-1449
Country	:	US
Telephone Number	:	479-636-8700
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	CEMYIRA MCDOUGAL
Credential	:
Telephone Number	:	217-764-8609

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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