Active NPI
Robert Stanton Kilcourse Jr., DDS
- Dentist
- Maitland, FL
National Provider Identifier
1386096261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN8053
- Practice address
- 630 Brookside Rd
Maitland, FL 32751-5127 - Phone
- (407) 230-5255
- NPI assigned
- Jul 5, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN8053 | FL | Primary |
| Dentist | 122300000X | 6417 | MD |
Addresses
Primary practice location
630 Brookside Rd
Maitland, FL 32751-5127
Mailing address
630 Brookside Rd
Maitland, FL 32751-5127
Phone (407) 230-5255
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 |
|---|---|---|---|
| DN8053 | FL | MD | Dentist |
| 6417 | MD | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467676800000",
"number": "1386096261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 BROOKSIDE RD",
"city": "MAITLAND",
"state": "FL",
"postal_code": "327515127",
"telephone_number": "407-230-5255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 BROOKSIDE RD",
"city": "MAITLAND",
"state": "FL",
"postal_code": "327515127",
"telephone_number": "407-230-5255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KILCOURSE",
"first_name": "ROBERT",
"middle_name": "STANTON",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-07-05",
"last_updated": "2016-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN8053",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MD",
"license": "6417",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maitland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.