Provider Demographics
NPI:1134217243
Name:NANCE, F. KENT (DDS)
Entity type:Individual
Prefix:
First Name:F. KENT
Middle Name:
Last Name:NANCE
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 1:3860 HIGHWAY 412 E
Mailing Address - Street 2:SUITE F
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-8510
Mailing Address - Country:US
Mailing Address - Phone:479-524-9379
Mailing Address - Fax:479-524-0976
Practice Address - Street 1:3860 HIGHWAY 412 E
Practice Address - Street 2:SUITE F
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-8510
Practice Address - Country:US
Practice Address - Phone:479-524-9379
Practice Address - Fax:479-524-0976
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR33691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X953OtherBCBS FEDERAL
AR789208OtherUNITED CONCORDIA