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General NPI Number Information
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NPI Number | 1851313746
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Entity Type | Organization
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Legal Business Name | KIM D. KEISNER, D.D.S., P.A.
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1493 FOREST HILLS BLVD SUITE C
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City | BELLA VISTA
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State | AR
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Zip | 72715-5068
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Country | US
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Telephone | 479-855-3313
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Fax |
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Provider Business Mailing Address
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Address Line | 1493 FOREST HILLS BLVD SUITE C
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City | BELLA VISTA
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State | AR
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Zip | 72715-5068
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Country | US
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Telephone | 479-855-3313
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KIM DAVID KEISNER
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Credential | D.D.S.
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Telephone | 479-855-3313
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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 | 2511
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License Number State | AR
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