Kenneth Scott Macpherson – Denturist

Key facts

NPI: 1215088166
Entity type: Individual (NPI type 1)
Primary specialty: Denturist 122400000X
License: MT18 (MT)
Practice address: 715 Kensington Ave
#25B
Missoula, MT 59801
Phone: (406) 542-0609
Fax: (406) 721-7617
NPI assigned: Jan 16, 2007
Sex: Male
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
MT18	MT	MD	Denturist

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Denturist	122400000X	MT18	MT	Yes

Addresses

Primary practice location

715 Kensington Ave
#25B
Missoula, MT 59801

Mailing address

715 Kensington Ave
#25B
Missoula, MT 59801
Phone (406) 542-0609

Other identifiers

Identifier	Type	State	Issuer
0150241	Medicaid	MT

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215088166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 KENSINGTON AVE",
            "address_2": "#25B",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "59801",
            "telephone_number": "406-542-0609",
            "fax_number": "406-721-7617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 KENSINGTON AVE",
            "address_2": "#25B",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "59801",
            "telephone_number": "406-542-0609",
            "fax_number": "406-721-7617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACPHERSON",
        "first_name": "KENNETH",
        "middle_name": "SCOTT",
        "name_prefix": "Mr.",
        "credential": "LD LICENSED DENTURIS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122400000X",
            "taxonomy_group": "",
            "desc": "Denturist",
            "state": "MT",
            "license": "MT18",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0150241",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

All providers in Missoula, MT · Denturist in Montana

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.