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General NPI Number Information
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NPI Number | 1457679342
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Entity Type | Individual
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Provider Name | DAVID KERNODLE DDS
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Gender | Male
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Dates
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Enumeration Date | 05/17/2010
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Last Update Date | 05/17/2010
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Provider Practice Location Address
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Address Line | 708 E DIXON RD
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City | LITTLE ROCK
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State | AR
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Zip | 72206-4114
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Country | US
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Telephone | 877-227-9892
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Fax | 623-321-6268
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Provider Business Mailing Address
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Address Line | 1904 W PARKSIDE LN SUITE 201
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City | PHOENIX
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State | AZ
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Zip | 85027-1228
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Country | US
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Telephone | 800-409-2563
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Fax | 623-321-6268
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1904
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License Number State | AR
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