Kenneth Charles Prince, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D4335 Issued in ID

Practice address

205 N Berkley Ave
Council, ID 83612

Phone

(208) 253-4242

NPI assigned

Jun 7, 2006

Last updated

Sep 13, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Adams County Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Council, ID
  • NPI 1710915897
  NPD (past)

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347494400000",
    "number": "1114967098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 428",
            "city": "COUNCIL",
            "state": "ID",
            "postal_code": "836120428",
            "telephone_number": "208-253-4242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N BERKLEY AVE",
            "city": "COUNCIL",
            "state": "ID",
            "postal_code": "83612",
            "telephone_number": "208-253-4242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRINCE",
        "first_name": "KENNETH",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2012-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D4335",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "527932",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "PR1900",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Douglas M. Linford, DO
• Mountains West Dental PLLC
• Valeda A Murray
• Payette Lakes Medical Clinic, PA
• Tawni Peterson
• Proactive Physical Therapy of McCall, PA
• Rogue River Sleep Dentistry
• Lisa H Shine, LMSW
• Mikayla Raylynn Shumway, RN
• Gregory Grant Smith, D.D.S.

• General Practice Dentistry in Council, ID
• Providers in Council, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2012; 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.