Provider Demographics
NPI:1487742060
Name:DUGAN, KEVIN M (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:DUGAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 SPRINGHILL DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2913
Mailing Address - Country:US
Mailing Address - Phone:501-758-9191
Mailing Address - Fax:501-758-3228
Practice Address - Street 1:3200 SPRINGHILL DR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2913
Practice Address - Country:US
Practice Address - Phone:501-758-9191
Practice Address - Fax:501-758-3228
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR24031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR187436631Medicaid