Provider Demographics
NPI:1093750101
Name:ARBUCKLE, KENT KINGDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:KINGDON
Last Name:ARBUCKLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-2292
Mailing Address - Country:US
Mailing Address - Phone:801-292-0733
Mailing Address - Fax:801-298-5336
Practice Address - Street 1:281 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-2292
Practice Address - Country:US
Practice Address - Phone:801-292-0733
Practice Address - Fax:801-298-5336
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT131153-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist