Kingdon Kibble Brady, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12010038A Issued in IN

Practice address

2627 Redwing Rd
Suite 300
Fort Collins, CO 80526-6321

Phone

(970) 484-0250

Fax

(970) 484-1522

NPI assigned

Apr 3, 2006

Sex

Male

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 Feb 4, 2016 through Feb 4, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1144022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451865600000",
    "number": "1255393765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2627 REDWING RD",
            "address_2": "SUITE 300",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805266321",
            "telephone_number": "970-484-0250",
            "fax_number": "970-484-1522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2627 REDWING RD",
            "address_2": "SUITE 300",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805266321",
            "telephone_number": "970-484-0250",
            "fax_number": "970-484-1522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADY",
        "first_name": "KINGDON",
        "middle_name": "KIBBLE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-03",
        "last_updated": "2016-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010038A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200231810",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Carter Bradley, MD
• Kara P Bradley, PAC
• Cynthia S. Bradrick, RN
• Bradshaw Voice and Speech LLC
• Natalie Bradshaw, MS CCC-SLP MSW SWC
• Samuel Brady, PA-C
• Sarah Rebecca Bragg
• Braintrust Services
• Katherine Carol Brakefield, RN
• Alison Brand

• General Practice Dentistry in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2016; 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.