Individual provider Active NPI

Kristin Elizabeth Salamon, D.D.S.

  • General Practice Dentistry
  • Tuba City, AZ
National Provider Identifier
1083902936
Registry record updated Jun 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D010245 Issued in AZ
Practice address
167 N Main St
Tuba City, AZ 86045-0600
Phone
(928) 283-2501
Fax
(928) 283-2677
NPI assigned
Jul 13, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 6, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019.028620 IL
General Practice Dentistry 1223G0001X D010245 AZ Primary

Addresses

Primary practice location

167 N Main St
Tuba City, AZ 86045-0600

Mailing address

PO Box 3630
Flagstaff, AZ 86003-3630
Phone (928) 522-9400

Other practice location 1

8617 W 98th St
Palos Hills, IL 60465-1131
Phone (708) 833-3668

Other names 1

  • Kristin McCalla Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20190415002841 AZ Practitioner - Dentist 7911248216
I20220615000133 TX Practitioner - Dentist 7911248216 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D010245AZMDGeneral Practice Dentistry
019.028620ILMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
North Country Healthcare, Inc. CurrentSince May 1, 2019 Accepting new patients
North Country Healthcare, Inc. Current Accepting new patients
Tuba City Regional Health Care Corporation CurrentSince Mar 28, 2022 Accepting new patients
Tuba City Regional Health Care Corporation General Practice Current Accepting new patients
Lechee Health Facility CurrentSince Mar 28, 2022 Accepting new patients
North Country Healthcare, Inc. CurrentSince May 1, 2019 Accepting new patients
North Country Healthcare, Inc. Current Accepting new patients

Locations

2920 N 4th St
Flagstaff, AZ 86004
Phone (928) 213-6100

1501 S Yale St
Ste 252
Flagstaff, AZ 86001
Phone (928) 774-1811

300 S 6th St
Williams, AZ 86046
Phone (928) 635-4441

620 Lee St
Winslow, AZ 86047
Phone (928) 288-8700

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1310515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1083902936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3630",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860033630",
            "telephone_number": "928-522-9400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 N MAIN ST",
            "city": "TUBA CITY",
            "state": "AZ",
            "postal_code": "860450600",
            "telephone_number": "928-283-2501",
            "fax_number": "928-283-2677"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8617 W 98th St",
            "address_purpose": "LOCATION",
            "city": "Palos Hills",
            "state": "IL",
            "postal_code": "604651131",
            "country_code": "US",
            "telephone_number": "708-833-3668",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SALAMON",
        "first_name": "KRISTIN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-13",
        "last_updated": "2022-06-06",
        "certification_date": "2022-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.028620",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D010245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTIN",
            "last_name": "MCCALLA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tuba City, AZ

Sources for this page

Verify at the official NPI Registry.