PREMIER DERMATOLOGY & SKIN RENEWAL CENTER
PREMIER DERMATOLOGY & SKIN RENEWAL CENTER is an organization registered with the National Plan and Provider Enumeration System (NPPES) under NPI 1912912361, based in Bentonville, AR. The organization lists 4 taxonomy classifications, with Clinical & Laboratory Dermatological Immunology Physician recorded as primary.
Getting there
The practice address on file is 909 SE 28TH ST STE 5, Bentonville, AR 72712. We have not yet mapped what surrounds this office — parking, transit, and nearby pharmacies are added as our data collection reaches each location.
Credentials and Medicare
| Licence | State | Specialty |
|---|---|---|
| E3363 | AR | Dermatology Physician |
| E3363 | AR | Pediatric Dermatology Physician |
| E3363 | AR | Procedural Dermatology Physician |
This provider holds licence E3363 issued in AR. A licence number in NPPES reflects what was filed at registration — it does not confirm the licence is still active today.
This NPI does not appear in the PECOS Medicare enrolment file. Providers who do not bill Medicare — or who bill only through a group's enrolment — will not appear here. It is not a sign of any problem with the registration.
What Clinical & Laboratory Dermatological Immunology covers
A dermatologist who utilizes various specialized laboratory procedures to diagnose disorders characterized by defective responses of the body's immune system. Immunodermatologists also may provide consultation in the management of these disorders and administer specialized forms of therapy for these diseases. NUCC Health Care Provider Taxonomy, code 207NI0002X
All registered taxonomy codes
This provider registers 4 taxonomy codes. The primary code is what appears on most claims; the others record additional recognised specialties.
| Code | Specialty | Licence | State | |
|---|---|---|---|---|
| 207NI0002X | Clinical & Laboratory Dermatological Immunology Physician Clinical & Laboratory Dermatological Immunology | — | AR | primary |
| 207N00000X | Dermatology Physician | E3363 | AR | |
| 207NP0225X | Pediatric Dermatology Physician Pediatric Dermatology | E3363 | AR | |
| 207NS0135X | Procedural Dermatology Physician Procedural Dermatology | E3363 | AR |
The taxonomy records how the provider classifies their own practice. It does not confirm which conditions they currently treat, whether they are accepting new patients, or which insurance they take — call the office for that.
Full NPPES record
An NPI-2 identifies an organization — a clinic, hospital, group practice, laboratory, or supplier. Individual clinicians working there hold their own NPI-1 numbers separately, so a bill may reference both.
| NPI | 1912912361 valid check digit |
|---|---|
| Entity type | Organization (NPI-2) |
| Enumeration date | Jul 31, 2006 |
| Last updated | Sep 11, 2025 |
| Status | Active |
| Practice address |
909 SE 28TH ST STE 5 Bentonville, AR 72712 (479) 273-3376 Fax (479) 273-3468 |
| Other identifiers |
1679521405
· Other (AR) 03060015000 · Other (AR) |
Number check
How the check works, step by step
Every NPI carries a Luhn check digit — the same scheme used on credit cards. CMS prefixes the number with 80840 before computing it, which marks it as a US health identifier.
| Digit | 8 | 0 | 8 | 4 | 0 | 1 | 9 | 1 | 2 | 9 | 1 | 2 | 3 | 6 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Doubled? | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 |
| Value | 8 | 0 | 8 | 8 | 0 | 2 | 9 | 2 | 2 | 9 | 1 | 4 | 3 | 3 |
Sum = 59 · next multiple of 10 = 60 · check digit = 1 · actual last digit = 1
A valid check digit only means the number is well-formed. It does not mean the provider is licensed, active, or in good standing — those are separate questions answered by the sections above.