Provider Demographics
NPI:1770508491
Name:KAUFFMAN, CHUCK (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHUCK
Middle Name:
Last Name:KAUFFMAN
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 1:305 GRAHAM ST
Mailing Address - Street 2:
Mailing Address - City:FORDYCE
Mailing Address - State:AR
Mailing Address - Zip Code:71742-3230
Mailing Address - Country:US
Mailing Address - Phone:870-352-2880
Mailing Address - Fax:
Practice Address - Street 1:305 GRAHAM ST
Practice Address - Street 2:
Practice Address - City:FORDYCE
Practice Address - State:AR
Practice Address - Zip Code:71742-3230
Practice Address - Country:US
Practice Address - Phone:870-352-2880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR23681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice