Provider Demographics
NPI:1568071595
Name:KITCHENS, JESSE BLAKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:BLAKE
Last Name:KITCHENS
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 1:465 MEDICAL CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031-7946
Mailing Address - Country:US
Mailing Address - Phone:501-745-8811
Mailing Address - Fax:501-475-5042
Practice Address - Street 1:465 MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-7946
Practice Address - Country:US
Practice Address - Phone:501-745-8811
Practice Address - Fax:501-745-5042
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR44451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice