Individual provider Active NPI

Kaianne Myleigh Conibear, D.D.S.

  • Dentist
  • Orlando, FL
National Provider Identifier
1073774378
Registry record updated Jun 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN 18349 Issued in FL
Practice address
7932 W Sand Lake Rd Ste 105
Orlando, FL 32819-7299
Phone
(407) 351-4229
NPI assigned
Jun 19, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN 18349 FL Primary

Addresses

Primary practice location

7932 W Sand Lake Rd Ste 105
Orlando, FL 32819-7299

Mailing address

11426 Claymont Cir
Windermere, FL 34786-5317
Phone (319) 621-0864

Other names 1

  • Dr. Kaianne Myleigh Clemenson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150720003150 FL Order and Referring Only - DentistPractitioner - Dentist 1153634142

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN 18349FLMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1213833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245196800000",
    "number": "1073774378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11426 CLAYMONT CIR",
            "city": "WINDERMERE",
            "state": "FL",
            "postal_code": "347865317",
            "telephone_number": "319-621-0864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7932 W SAND LAKE RD STE 105",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328197299",
            "telephone_number": "407-351-4229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONIBEAR",
        "first_name": "KAIANNE",
        "middle_name": "MYLEIGH",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-19",
        "last_updated": "2009-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN 18349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAIANNE",
            "last_name": "CLEMENSON",
            "middle_name": "MYLEIGH",
            "prefix": "DR.",
            "credential": "D.D.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.