Active NPI
Kevin Kryder, D.D.S.
- Dental Anesthesiology
- Phoenix, AZ
National Provider Identifier
1083015101
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Anesthesiology
- License
- D012102
- Practice address
- 3202 E Greenway Rd Ste 1287
Phoenix, AZ 85032-4550 - Phone
- (503) 887-0181
- NPI assigned
- Sep 8, 2014
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dental Anesthesiology | 1223D0004X | D012102 | AZ | Primary |
Addresses
Primary practice location
3202 E Greenway Rd Ste 1287
Phoenix, AZ 85032-4550
Mailing address
3600 Forbes Avenue
Forbes Tower - Plaza Level Suite 140
Pittsburgh, PA 15213-3410
Phone (503) 887-0181
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150824001121 | OR | Order and Referring Only - Other (Physician) | 0648585422 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D012102 | AZ | MD | Dentist Anesthesiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715731200000",
"number": "1083015101",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3600 FORBES AVENUE",
"address_2": "FORBES TOWER - PLAZA LEVEL SUITE 140",
"city": "PITTSBURGH",
"state": "PA",
"postal_code": "152133410",
"telephone_number": "503-887-0181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3202 E GREENWAY RD STE 1287",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850324550",
"telephone_number": "503-887-0181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRYDER",
"first_name": "KEVIN",
"name_prefix": "Mr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-09-08",
"last_updated": "2024-05-15",
"certification_date": "2024-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223D0004X",
"taxonomy_group": "",
"desc": "Dentist, Dental Anesthesiology",
"state": "AZ",
"license": "D012102",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; 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.