Ken Wood, D.D.S. M.S. Childrens Dentistry

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

2738 Issued in AR

Legal business name

KEN WOOD, D.D.S. M.S. CHILDRENS DENTISTRY

Practice address

2702 S Culberhouse St
Suite Q
Jonesboro, AR 72401-7132

Phone

(870) 931-5437

Fax

(870) 931-9781

NPI assigned

Apr 12, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kenneth I Wood, D.D.S., M.S.

Title

Doctor

Phone

(870) 931-5437

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ken I Wood, DDS MS

  • Pediatric Dentistry
  • Jonesboro, AR
  • NPI 1548360001
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184716800000",
    "number": "1790909752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1369",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724031369",
            "telephone_number": "870-931-5437",
            "fax_number": "870-931-9781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2702 S CULBERHOUSE ST",
            "address_2": "SUITE Q",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724017132",
            "telephone_number": "870-931-5437",
            "fax_number": "870-931-9781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEN WOOD, D.D.S. M.S. CHILDRENS DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2007-07-18",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "870-931-5437",
        "authorized_official_credential": "D.D.S., M.S."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AR",
            "license": "2738",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "828134",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARKANSAS BLUE CROSS BLUE",
            "identifier": "59239",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laderek Kelly
• Rhonda Kelly
• Madi Kelso, PLMSW
• Charles E Kemp, M.D.
• Joanne Kemp
• Constance Kennedy
• Damon Mark Kennedy, DO
• Jayme Kennedy
• Kinley Kennedy
• Lyle Kennedy, RN

• Pediatric Dentistry in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Pediatric Dentistry in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.