Provider Demographics
NPI:1699811539
Name:JONES, KEVIN GLEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:GLEN
Last Name:JONES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11600 KANIS RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3727
Mailing Address - Country:US
Mailing Address - Phone:501-225-4555
Mailing Address - Fax:501-258-3738
Practice Address - Street 1:11600 KANIS RD
Practice Address - Street 2:SUITE 800
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3727
Practice Address - Country:US
Practice Address - Phone:501-225-4555
Practice Address - Fax:501-258-3738
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3361122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist