Active NPI
Jeffrey W Kilgore, D.M.D.
- Dentist
- Fairbanks, AK
National Provider Identifier
1003062456
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1277
- Practice address
- 1606 23Rd Ave
Fairbanks, AK 99701-6407 - Phone
- (907) 455-4567
- Fax
- (907) 458-1589
- NPI assigned
- Aug 15, 2008
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 1277 | AK | Primary |
Addresses
Primary practice location
1606 23Rd Ave
Fairbanks, AK 99701-6407
Mailing address
1606 23Rd Ave
Fairbanks, AK 99701-6407
Phone (907) 455-4567
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AK
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160105002754 | AK | Order and Referring Only - Other (Non-Physician) | 6204138431 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219795200000",
"number": "1003062456",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1606 23RD AVE",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997016407",
"telephone_number": "907-455-4567",
"fax_number": "907-458-1589"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1606 23RD AVE",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997016407",
"telephone_number": "907-455-4567",
"fax_number": "907-458-1589"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KILGORE",
"first_name": "JEFFREY",
"middle_name": "W",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-08-15",
"last_updated": "2008-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AK",
"license": "1277",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.