Provider Demographics
NPI:1053040600
Name:HARGIS, KYLE JORDAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:JORDAN
Last Name:HARGIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 DORAL DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-2919
Mailing Address - Country:US
Mailing Address - Phone:870-390-0722
Mailing Address - Fax:
Practice Address - Street 1:520 W PERSHING BLVD STE C
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-2100
Practice Address - Country:US
Practice Address - Phone:501-753-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4608122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist