Provider Demographics
NPI:1528026754
Name:KILPATRICK, STEVEN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
Last Name:KILPATRICK
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 1:2909 S 74TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5156
Mailing Address - Country:US
Mailing Address - Phone:479-452-7454
Mailing Address - Fax:
Practice Address - Street 1:2909 S 74TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5156
Practice Address - Country:US
Practice Address - Phone:479-452-7454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR21621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102828608Medicaid
ART20440Medicare UPIN
AR102828608Medicaid