Individual
WALTER GENE JINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
12501 CANTRELL ROAD, LITTLE ROCK, AR 72223
(501) 223-3838
(501) 223-2554
Mailing address
12501 CANTRELL ROAD, LITTLE ROCK, AR 72223
(501) 223-3838
(501) 223-2554
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2158
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102068608
—
AR
01
—
2158
DELTA DENTAL OF AR
AR
01
—
58928
AR LUE CROSS BLUE SHIELD
AR
01
—
617338
UNITED CONCORDIA
AR
Enumeration date
11/08/2006
Last updated
07/08/2007
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