Provider Demographics
NPI:1265528400
Name:PERKINS, KENNETH TILMAN (DDS PA)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:TILMAN
Last Name:PERKINS
Suffix:
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 DURANCE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-9133
Mailing Address - Country:US
Mailing Address - Phone:501-868-1300
Mailing Address - Fax:504-868-1327
Practice Address - Street 1:6020 RANCH DR STE C6
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-4635
Practice Address - Country:US
Practice Address - Phone:501-868-1300
Practice Address - Fax:501-868-1327
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5613189041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y260Medicare UPIN
AR561318904Medicare UPIN
AR463088Medicare UPIN