Kenneth Edwards, DMD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

2016006251 Issued in MO

Practice address

1205 NE Coronado Dr
Blue Springs, MO 64014-2928

Phone

(816) 228-4090

NPI assigned

Aug 10, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Alex Sharifian DDS Blue Springs Dentistry PC

  dba Blue Springs Dentistry

  • General Practice Dentistry
  • Blue Springs, MO
  • NPI 1083027411
  NPD (past)

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

{
    "created_epoch": "1470787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1114471943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2622 S 13TH ST",
            "address_2": "FRNT",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631181804",
            "telephone_number": "314-309-4494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 NE CORONADO DR",
            "city": "BLUE SPRINGS",
            "state": "MO",
            "postal_code": "640142928",
            "telephone_number": "816-228-4090"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2622 S 13th St",
            "address_2": "Frnt",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631181804",
            "country_code": "US",
            "telephone_number": "217-851-0235",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "KENNETH",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-08-10",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2016006251",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MO",
            "license": "2016006251",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dynamic Chiropractic LLC
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• Edward J. Bazar DMD, P.C.
• Micheala E Edwards, DC
• Mary Katherine Eikermann, APRN
• Elevate Life Chiropractic, LLC (Elevate Life Chiropractic)
• Elizabeth V Hackleman, D.C., P.C.
• Bev Emery

• Orthodontics and Dentofacial Orthopedics Dentistry in Blue Springs, MO
• Providers in Blue Springs, MO by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.

Verify at the official NPI Registry.