Active NPI
Kenneth Hermsen, DDS
- Endodontics
- Council Bluffs, IA
National Provider Identifier
1285041541
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 09077
- Practice address
- 114 1/2 S. 6TH Street
Council Bluffs, IA 51501-4324 - Phone
- (712) 256-5048
- Fax
- (712) 256-4832
- NPI assigned
- Jul 18, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 09077 | IA | Primary |
Addresses
Primary practice location
114 1/2 S. 6TH Street
Council Bluffs, IA 51501-4324
Mailing address
114 1/2 S 6TH St
Council Bluffs, IA 51501-4234
Phone (712) 256-5048
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 09077 | IA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405641600000",
"number": "1285041541",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "114 1/2 S 6TH ST",
"city": "COUNCIL BLUFFS",
"state": "IA",
"postal_code": "515014234",
"telephone_number": "712-256-5048",
"fax_number": "712-256-4832"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "114 1/2 S. 6TH STREET",
"city": "COUNCIL BLUFFS",
"state": "IA",
"postal_code": "515014324",
"telephone_number": "712-256-5048",
"fax_number": "712-256-4832"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERMSEN",
"first_name": "KENNETH",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-07-18",
"last_updated": "2014-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "IA",
"license": "09077",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Council Bluffs, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.