MEDICARE: BORENGASSER FAMILY DENTAL, PLLC

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	261QD0000X	Dental Clinic/Center	3525	AR

General Provider Information

NPI Number	:	1346756103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BORENGASSER FAMILY DENTAL, PLLC

Provider Business Mailing Address
First Line	:	9205 ROSEWOOD DR
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-7060
Country	:	US
Telephone Number	:	479-719-1373
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	:	DENTIST
Name	:	DR. JAMES WESLEY BORENGASSER
Credential	:	DDS
Telephone Number	:	479-242-3340

Provider Enumeration Date	:	12/15/2017
Last Update Date	:	12/15/2017

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