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General NPI Number Information
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NPI Number | 1174706725
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Entity Type | Organization
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Legal Business Name | KITCHENS PEDIATRIC DENTISTRY, PLLC
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Dates
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Enumeration Date | 12/06/2007
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Last Update Date | 12/28/2011
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Provider Practice Location Address
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Address Line | 14114 TAYLOR LOOP RD
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City | LITTLE ROCK
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State | AR
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Zip | 72223
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Country | US
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Telephone | 501-868-3331
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Fax | 501-868-5323
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Provider Business Mailing Address
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Address Line | 14114 TAYLOR LOOP RD.
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City | LITTLE ROCK
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State | AR
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Zip | 72223
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Country | US
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Telephone | 501-868-3331
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Fax | 501-868-5323
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. CLOVIS ANDREW KITCHENS
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Credential | DDS
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Telephone | 501-868-3331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 3512
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2186
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License Number State | AR
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