Illuminate Family Dentistry, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ILLUMINATE FAMILY DENTISTRY, LLC

Practice address

250 W Red Powell Dr Ste 500
Derby, KS 67037-2626

Phone

(316) 847-7730

NPI assigned

Feb 4, 2022

Last updated

Feb 4, 2022By 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. Rachel Hayes Clark, DDSNPI 1720570484

Title

Owner Dentist

Phone

(316) 847-7730

Specialties & licenses 1

Addresses

Locations

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.

• Rachel Hayes Clark, DDS

  • Dentist
  • Wichita, KS
  • NPI 1720570484
  NPD Authorized official

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

{
    "created_epoch": "1643932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643932800000",
    "number": "1316691736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2113 N WOODARD ST",
            "city": "DERBY",
            "state": "KS",
            "postal_code": "670372364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 W RED POWELL DR STE 500",
            "city": "DERBY",
            "state": "KS",
            "postal_code": "670372626",
            "telephone_number": "316-847-7730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLUMINATE FAMILY DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-04",
        "last_updated": "2022-02-04",
        "certification_date": "2022-02-04",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "RACHEL",
        "authorized_official_middle_name": "HAYES",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "316-847-7730",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chrisinda Lyn Hunter, MS, T-MFT
• Jennifer Hurd, LSCSW
• Esmeralda Ludivina Ibarra
• Kimberly Louise Ignowski, NP-C
• Shelly L Igo, RN
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• Infinite Abilities LLC
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• Integrity Ats, Inc.
• Zane Ali Issa, DDS

• General Practice Dentistry in Derby, KS
• Providers in Derby, KS by specialty
• General Practice Dentistry in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2022; 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.