Provider Demographics
NPI:1457375420
Name:KAUFFMAN, JAMES TIMOTHY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TIMOTHY
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 1:811 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-5923
Mailing Address - Country:US
Mailing Address - Phone:870-246-2221
Mailing Address - Fax:870-246-2532
Practice Address - Street 1:811 CLINTON ST
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-5923
Practice Address - Country:US
Practice Address - Phone:870-246-2221
Practice Address - Fax:870-246-2532
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR25541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR109979608Medicaid
AR112046OtherUNITED CONCORDIA
AR56585OtherBLUE CROSS/BLUE SHIELD