Provider Demographics
NPI:1982883039
Name:KEVIN S. PIERCE, D.D.S. P.A.
Entity Type:Organization
Organization Name:KEVIN S. PIERCE, D.D.S. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-268-8600
Mailing Address - Street 1:1724 EXECUTIVE SQ
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6092
Mailing Address - Country:US
Mailing Address - Phone:870-268-8600
Mailing Address - Fax:870-268-0044
Practice Address - Street 1:1724 EXECUTIVE SQ
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6092
Practice Address - Country:US
Practice Address - Phone:870-268-8600
Practice Address - Fax:870-268-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR33981223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5-X034OtherARBCBS
1397202OtherUNITED CONCORDIA
AR14824631Medicaid
2114424OtherBCBSTN