Kenneth Alexander Poole II, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6081 Issued in NC

Practice address

2835 Horse Pen Creek Rd Ste 106
Greensboro, NC 27410-9700

Phone

(336) 662-0807

Fax

(336) 662-0828

NPI assigned

Jul 7, 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 6

Medicare fee-for-service enrollment

Enrolled in NC

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• K. Alex Poole II

  • General Practice Dentistry
  • Greensboro, NC
  • NPI 1952497349
  NPD (past)

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1376576207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4020 DUPLIN DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274077763",
            "telephone_number": "336-315-0943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2835 HORSE PEN CREEK RD STE 106",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274109700",
            "telephone_number": "336-662-0807",
            "fax_number": "336-662-0828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POOLE",
        "first_name": "KENNETH",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "6081",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8996986",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ALABAMA",
            "identifier": "810-41",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PENN. BLUE SHIELD",
            "identifier": "864646",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TENN.",
            "identifier": "40706",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "96986",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TEXAS",
            "identifier": "V0068",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wyatt Henry Pommier
• Amanda Solanda Pone, RN
• Heather Pool
• Henry Andrae Pool, M.D.
• Felicia Poole, MED
• Mariani Poole
• Caitlin Elizabeth Poore, PAC
• Liviu E Pop, MD
• Judith Pope Ward, PH.D.
• Christina Pope, OTR/L

• General Practice Dentistry in Greensboro, NC
• Providers in Greensboro, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.