Active NPI
Kunal Patel
- Dentist
- Lexington, KY
National Provider Identifier
1063159911
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 10831
- Practice address
- 3122 Custer Dr
Lexington, KY 40517-4000 - Phone
- (859) 273-5020
- NPI assigned
- May 12, 2022
- Last updated
- Jul 18, 2024
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 10831 | KY | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
3122 Custer Dr
Lexington, KY 40517-4000
Mailing address
103 Gibson Way
Winchester, KY 40391-8324
Other practice location 1
101 Jett Blvd Ste 100
Frankfort, KY 40601-7778
Phone (502) 871-3525
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10831 | KY | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Interim Dent PLLC | Dentist | Current | Accepting new patients |
Locations
3122 Custer Dr
Lexington, KY 40517
Phone (859) 273-2224
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652313600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721260800000",
"number": "1063159911",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "103 GIBSON WAY",
"city": "WINCHESTER",
"state": "KY",
"postal_code": "403918324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3122 CUSTER DR",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405174000",
"telephone_number": "859-273-5020"
}
],
"practiceLocations": [
{
"address_1": "101 Jett Blvd Ste 100",
"address_purpose": "LOCATION",
"city": "Frankfort",
"state": "KY",
"postal_code": "406017778",
"country_code": "US",
"telephone_number": "502-871-3525",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PATEL",
"first_name": "KUNAL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-05-12",
"last_updated": "2024-07-18",
"certification_date": "2024-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "10831",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Lexington, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.