Provider Demographics
NPI:1285220038
Name:ALEXANDER S KITA, DDS, PA
Entity Type:Organization
Organization Name:ALEXANDER S KITA, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:KITA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-758-9697
Mailing Address - Street 1:3517 JFK BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-8839
Mailing Address - Country:US
Mailing Address - Phone:501-758-9697
Mailing Address - Fax:501-758-9699
Practice Address - Street 1:3517 JFK BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-8839
Practice Address - Country:US
Practice Address - Phone:501-758-9697
Practice Address - Fax:501-758-9699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR235252608Medicaid