Quail Crest Imaging, LLC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

6357 Issued in KS

Legal business name

QUAIL CREST IMAGING, LLC

Practice address

4830 Quail Crest PL Ste B
Lawrence, KS 66049-3842

Phone

(785) 856-0117

Fax

(785) 856-5082

NPI assigned

Jan 5, 2015

Organization subpart

No

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

Authorized official

Name

Gretchen Edwards, RDH

Title

Office Manager

Phone

(785) 856-0117

Specialties & licenses 4

Addresses

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

{
    "created_epoch": "1420416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420416000000",
    "number": "1104214816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4830 QUAIL CREST PL STE B",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "660493842",
            "telephone_number": "785-856-0117",
            "fax_number": "785-856-5082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4830 QUAIL CREST PL STE B",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "660493842",
            "telephone_number": "785-856-0117",
            "fax_number": "785-856-5082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUAIL CREST IMAGING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-05",
        "last_updated": "2015-01-05",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "GRETCHEN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "785-856-0117",
        "authorized_official_credential": "RDH"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "KS",
            "license": "6944",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "KS",
            "license": "6357",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "KS",
            "license": "60071",
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": "KS",
            "license": "1885",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Lawrence, KS
• Providers in Lawrence, KS by specialty
• Periodontics in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.