Healthcare Provider Details

I. General information

NPI: 1821103078
Provider Name (Legal Business Name): CHARLES KEMP CHILDS JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 HWY 463 N
TRUMANN AR
72472
US

IV. Provider business mailing address

143 HWY 463 N
TRUMANN AR
72472
US

V. Phone/Fax

Practice location:
  • Phone: 870-483-7654
  • Fax: 870-486-7047
Mailing address:
  • Phone: 870-483-7654
  • Fax: 870-486-7047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2610
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: