Individual provider Active NPI

Kris Andrew Volcheck, DDS

  • General Practice Dentistry
  • Phoenix, AZ
National Provider Identifier
1104937606
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3480 Issued in AZ
Practice address
230 S 12TH Ave
Phoenix, AZ 85007-3101
Phone
(602) 256-6945
Fax
(602) 417-9803
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 3480 AZ Primary

Addresses

Primary practice location

230 S 12TH Ave
Phoenix, AZ 85007-3101

Mailing address

230 S 12TH Ave
Phoenix, AZ 85007-3101
Phone (602) 256-6945

Other identifiers 1

IdentifierTypeStateIssuer
794736OtherAZAHCCCS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201223001632 AZ Practitioner - DentistPractitioner - Maxillofacial SurgeryPractitioner - Oral Surgery 1658783295 Practice locations: Phoenix, AZ

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Brighter Way Institute Dentist PastSince Jul 1, 2016 Accepting new patients
Brighter Way Institute Dentist PastSince Jul 1, 2016 Accepting new patients

Organizations & group practices 2

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104937606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 S 12TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850073101",
            "telephone_number": "602-256-6945",
            "fax_number": "602-417-9803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 S 12TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850073101",
            "telephone_number": "602-256-6945",
            "fax_number": "602-417-9803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VOLCHECK",
        "first_name": "KRIS",
        "middle_name": "ANDREW",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "3480",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "794736",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.