Active NPI
Brad R Jenkins, DDS
- General Practice Dentistry
- Fort Scott, KS
National Provider Identifier
1295873727
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- KS 7195
- Practice address
- 1115 S Main St
Fort Scott, KS 66701-2651 - Phone
- (620) 223-4448
- NPI assigned
- Feb 5, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | KS 7195 | KS | Primary |
Addresses
Primary practice location
1115 S Main St
Fort Scott, KS 66701-2651
Mailing address
13849 Meadow Cir
Leawood, KS 66224-4565
Phone (913) 685-3323
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100350890E | Medicaid | KS |
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 |
|---|---|---|---|
| KS 7195 | KS | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391040000000",
"number": "1295873727",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13849 MEADOW CIR",
"city": "LEAWOOD",
"state": "KS",
"postal_code": "662244565",
"telephone_number": "913-685-3323"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1115 S MAIN ST",
"city": "FORT SCOTT",
"state": "KS",
"postal_code": "667012651",
"telephone_number": "620-223-4448"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENKINS",
"first_name": "BRAD",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-05",
"last_updated": "2014-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "KS",
"license": "KS 7195",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100350890E",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Scott, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 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.