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General NPI Number Information
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NPI Number | 1669981239
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Entity Type | Organization
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Legal Business Name | KINARD DENTISTRY, LLC
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Dates
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Enumeration Date | 09/26/2017
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Last Update Date | 12/24/2018
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Provider Practice Location Address
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Address Line | 1215 MILITARY RD STE 5
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City | BENTON
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State | AR
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Zip | 72015-2937
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Country | US
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Telephone | 501-315-5574
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Fax |
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Provider Business Mailing Address
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Address Line | 1215 MILITARY RD STE 3
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City | BENTON
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State | AR
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Zip | 72015-2937
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MICHAEL KINARD
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Credential | D.D.S.
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Telephone | 870-500-8155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 4094
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License Number State | AR
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