Waveland Family Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

08656 Issued in IA

Legal business name

WAVELAND FAMILY DENTAL

Practice address

4232 University Ave
Des Moines, IA 50311-3422

Phone

(515) 277-4461

NPI assigned

Feb 25, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Kevin Paul Baker, DDSNPI 1013144476

Title

Owner Dentist

Phone

(515) 556-4530

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kevin Paul Baker, D.D.S.

  • Dentist
  • Des Moines, IA
  • NPI 1013144476
  NPD Authorized official

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

{
    "created_epoch": "1487980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612310400000",
    "number": "1174063010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4232 UNIVERSITY AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503113422",
            "telephone_number": "515-277-4461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4232 UNIVERSITY AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503113422",
            "telephone_number": "515-277-4461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAVELAND FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-25",
        "last_updated": "2021-02-03",
        "certification_date": "2021-01-26",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "515-556-4530",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "08656",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "08656",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Des Moines, IA
• Providers in Des Moines, IA by specialty
• General Practice Dentistry in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; 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.