Organization
RUSSELLVILLE FAMILY DENTISTRY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL GREGORY KITCHENS D.D.S. (PRESIDENT)
(479) 968-1706
Entity
Organization
Contact information
Practice address
104 N UTAH AVE, RUSSELLVILLE, AR 72801-2740
(479) 968-1706
Mailing address
104 N UTAH AVE, RUSSELLVILLE, AR 72801-2740
(479) 968-1706
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3895
AR
Other
Enumeration date
12/25/2013
Last updated
12/25/2013
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