Kevin Mudrow DDS PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

KEVIN MUDROW DDS PLLC

Doing business as

Mudrow Family Dental

Practice address

333 S Woodruff Ave
Idaho Falls, ID 83401-4322

Phone

(208) 524-2036

NPI assigned

Sep 24, 2013

Last updated

Sep 24, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kevin Richard Mudrow, DDSNPI 1114126992

Title

Owner/General Dentist

Phone

(208) 524-2036

Specialties & licenses 1

Addresses

Other names 1

• Mudrow Family Dental Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kevin Richard Mudrow, D.D.S.

  • Dentist
  • Idaho Falls, ID
  • NPI 1114126992
  Authorized official Same address or phone

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

{
    "created_epoch": "1379980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379980800000",
    "number": "1235565003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83401",
            "telephone_number": "208-524-2036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014322",
            "telephone_number": "208-524-2036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN MUDROW DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-24",
        "last_updated": "2013-09-24",
        "status": "A",
        "authorized_official_last_name": "MUDROW",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER/GENERAL DENTIST",
        "authorized_official_telephone_number": "208-524-2036",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mudrow Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rachel Kent, BS
• Jennifer Dee Kerner, LCPC
• Dallin Kersey
• Ketamine Infusions of Idaho
• Traci Alene Kettle
• Kayla Nicole Key
• Mark Keyes, PHARMD
• Keystone Hospital Partners
• Muad Khallad, MD
• Muhammad Arslan Khan, M.D.

• Dentist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2013; 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.