Provider Demographics
NPI:1528123569
Name:SEDDENS, KEVIN BLAKE (DDS)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:BLAKE
Last Name:SEDDENS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:B
Other - Last Name:SEDDENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9505 TENNESSEE ROAD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1339
Mailing Address - Country:US
Mailing Address - Phone:870-773-1392
Mailing Address - Fax:
Practice Address - Street 1:1401 DUDLEY STREET
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-6331
Practice Address - Country:US
Practice Address - Phone:870-773-2095
Practice Address - Fax:870-772-0864
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2025-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR30261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR122456608Medicaid