Kathleen Good Ederle, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2739 Issued in AR

Practice address

413 N. University Ave.
Little Rock, AR 72205

Phone

(501) 664-6040

Fax

(501) 537-0479

NPI assigned

Oct 12, 2012

Sex

Female

Sole proprietor

Yes

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 Apr 14, 2015 through Apr 14, 2027

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 and National Provider Directory roles.

• Kathleen Good Ederle DDS PA

  • General Practice Dentistry
  • Little Rock, AR
  • NPI 1336280601
  NPD (past) Authorized official

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

{
    "created_epoch": "1350000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350000000000",
    "number": "1174875249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 N. UNIVERSITY AVE.",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "72205",
            "telephone_number": "501-664-6040",
            "fax_number": "501-537-0479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 N. UNIVERSITY AVE.",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "72205",
            "telephone_number": "501-664-6040",
            "fax_number": "501-537-0479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDERLE",
        "first_name": "KATHLEEN",
        "middle_name": "GOOD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-12",
        "last_updated": "2012-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AR",
            "license": "2739",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TN",
            "identifier": "1223G0001X",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Larkin Kathleen Eddleman, OTR
• Caroline Eddy
• Chinedu D Ede, M.D
• Edem Clinic PLLC
• Dinesh Laxminara Edem
• Katherine Leigh Edgar, OTR/L
• Otis H Edge, MD
• Dennis Edington, QBHP
• Sharena Star Edington, NP
• Michael J Edmison, APN

• Dentist in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Dentist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2012; 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.