Provider Demographics
NPI:1043305170
Name:KITCHENS' PEDIATRIC DENTISTRY P.A.
Entity Type:Organization
Organization Name:KITCHENS' PEDIATRIC DENTISTRY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLOVIS
Authorized Official - Middle Name:ANDY
Authorized Official - Last Name:KITCHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-223-0822
Mailing Address - Street 1:10310 W MARKHAM ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2175
Mailing Address - Country:US
Mailing Address - Phone:501-223-0822
Mailing Address - Fax:501-221-9420
Practice Address - Street 1:10310 W MARKHAM ST
Practice Address - Street 2:SUITE 202
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2175
Practice Address - Country:US
Practice Address - Phone:501-223-0822
Practice Address - Fax:501-221-9420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR31861223P0221X
AR35121223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty