Bradley Edholm King, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1663 Issued in ND

Practice address

121 E Front Ave
Bismarck, ND 58504-5589

Phone

(701) 223-1194

NPI assigned

Aug 30, 2006

Last updated

Jul 8, 2007By 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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Sep 2, 2017 through Sep 2, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Prairie Rose Family Dentists

  • Dentist
  • Bismarck, ND
  • NPI 1144391632
  Authorized official Same address or phone

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174633036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "737 MUNICH DR",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585047042",
            "telephone_number": "701-258-7579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 E FRONT AVE",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585045589",
            "telephone_number": "701-223-1194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "BRADLEY",
        "middle_name": "EDHOLM",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ND",
            "license": "1663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41242",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrea A. Kilzer, FNP
• Jeanne Kilzer
• Thomas M Kilzer, O.D.
• Ashlyn Kincaid
• Steven James Kindel, M.D.
• Christine King
• Kayla King, LAC, MSW
• Rebecca J King, LRD
• Breanna Kingsley
• Nicole Marie Kinn, MS, OTR/L

• General Practice Dentistry in Bismarck, ND
• Providers in Bismarck, ND by specialty
• General Practice Dentistry in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.