Kurt R Childress, DMD
Individual provider Active NPI General Practice Dentistry · Hindman, KY
NPI 1154463818 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1154463818
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 6629 (KY)
- Practice address
- 566 Highway 899
Hindman, KY 41822-0849 - Phone
- (606) 785-3164
- Fax
- (606) 785-0107
- NPI assigned
- Feb 12, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180921000038 | TX | Order and Referring Only - Oral Surgery |
0749531382 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6629 | KY | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6629 | KY | Yes |
Addresses
Primary practice location
566 Highway 899
Hindman, KY 41822-0849
Mailing address
566 Hwy 899
Hindman, KY 41822
Phone (606) 785-3164
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60066297 | Medicaid | KY |
Other providers in Hindman, KY
- Barbara Jones
- Kenneth Boggs
- Burnice Napier, Inc. Dba Napier Family Drug
- Hailey L. Champion Caudill
- Angie Ceelok Chan
- Victoria Alexis Click
- Melissa Candis Collett
- Kristen Danielle Combs
- Cornerstone Community Health
- Justin Taylor Cornett
All providers in Hindman, KY · General Practice Dentistry in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.