Provider Demographics
NPI:1588777056
Name:AHRENS, JOHN T (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:AHRENS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 E.7TH STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653
Mailing Address - Country:US
Mailing Address - Phone:870-425-3730
Mailing Address - Fax:870-425-1504
Practice Address - Street 1:403 E 7TH ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3948
Practice Address - Country:US
Practice Address - Phone:870-425-3730
Practice Address - Fax:870-425-1504
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR20421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58015OtherFEDERAL BCBS
AR868720OtherUNITED CONCORDIA