=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336155225
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN SCOTT PIERCE DDS,PA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1724 EXECUTIVE SQUIRE
-----------------------------------------------------
City | JONESBORO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-268-8600
-----------------------------------------------------
Fax | 870-268-0044
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1724 EXECUTIVE SQ
-----------------------------------------------------
City | JONESBORO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72401-6092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-268-8600
-----------------------------------------------------
Fax | 870-268-0044
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 3398
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------