1265528400 NPI number — DR. KENNETH TILMAN PERKINS DDS PA

Table of content: DR. KENNETH TILMAN PERKINS DDS PA (NPI 1265528400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265528400 NPI number — DR. KENNETH TILMAN PERKINS DDS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERKINS
Provider First Name:
KENNETH
Provider Middle Name:
TILMAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS PA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265528400
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 DURANCE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72223-9133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-868-1300
Provider Business Mailing Address Fax Number:
504-868-1327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6020 RANCH DR STE C6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72223-4635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-868-1300
Provider Business Practice Location Address Fax Number:
501-868-1327
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  561318904 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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