Active NPI
Clovis Andrew Kitchens, D.D.S. M.S
- Pediatric Dentistry
- Little Rock, AR
National Provider Identifier
1336298066
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 2186
- Practice address
- 14114 Taylor Loop Rd
Little Rock, AR 72223 - Phone
- (501) 868-3331
- Fax
- (501) 868-5323
- NPI assigned
- Jan 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 2186 | AR | Primary |
Addresses
Primary practice location
14114 Taylor Loop Rd
Little Rock, AR 72223
Mailing address
14114 Taylor Loop Rd.
Little Rock, AR 72223
Phone (501) 868-3331
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 58373 | Other | AR | BCBS ID # |
| 156309631 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kitchens Pediatric Dentistry, PLLC | Pediatric Dentistry | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatric Dentistry
- Little Rock, AR
- NPI 1174706725
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325030400000",
"number": "1336298066",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14114 TAYLOR LOOP RD.",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "72223",
"telephone_number": "501-868-3331",
"fax_number": "501-868-5323"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14114 TAYLOR LOOP RD",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "72223",
"telephone_number": "501-868-3331",
"fax_number": "501-868-5323"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KITCHENS",
"first_name": "CLOVIS",
"middle_name": "ANDREW",
"name_prefix": "Dr.",
"credential": "D.D.S. M.S",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-10",
"last_updated": "2011-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, Pediatric Dentistry",
"state": "AR",
"license": "2186",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS ID #",
"identifier": "58373",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "156309631",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.