Provider Demographics
NPI:1598879264
Name:DAVID R. KERNODLE, D.D.S.,P.C.
Entity Type:Organization
Organization Name:DAVID R. KERNODLE, D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:KERNODLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-741-6726
Mailing Address - Street 1:715 W SHERMAN AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2743
Mailing Address - Country:US
Mailing Address - Phone:870-741-6726
Mailing Address - Fax:870-741-0164
Practice Address - Street 1:715 W SHERMAN AVE
Practice Address - Street 2:SUITE H
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2743
Practice Address - Country:US
Practice Address - Phone:870-741-6726
Practice Address - Fax:870-741-0164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR19041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty