Active NPI
Jason Lynn Pendley, DMD
- Dentist
- Owensboro, KY
National Provider Identifier
1154586758
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 8635
- Practice address
- 4921 Goetz LN
Owensboro, KY 42301-9663 - Phone
- (270) 926-0190
- Fax
- (270) 926-7596
- NPI assigned
- Jul 23, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 8635 | KY | Primary |
Addresses
Primary practice location
4921 Goetz LN
Owensboro, KY 42301-9663
Mailing address
4921 Goetz LN
Owensboro, KY 42301-9663
Phone (270) 926-0190
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8635 | Other | KY | DENTAL INSURANCE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8635 | KY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303344000000",
"number": "1154586758",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4921 GOETZ LN",
"city": "OWENSBORO",
"state": "KY",
"postal_code": "423019663",
"telephone_number": "270-926-0190",
"fax_number": "270-926-7596"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4921 GOETZ LN",
"city": "OWENSBORO",
"state": "KY",
"postal_code": "423019663",
"telephone_number": "270-926-0190",
"fax_number": "270-926-7596"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENDLEY",
"first_name": "JASON",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-07-23",
"last_updated": "2011-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "8635",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL INSURANCE",
"identifier": "8635",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Owensboro, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.