Emerald Dental P.a.

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

EMERALD DENTAL P.A.

Practice address

1629 Poyntz Ave
Manhattan, KS 66502-4148

Phone

(785) 776-1771

NPI assigned

Oct 25, 2021

Last updated

Oct 25, 2021By 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

Creed Cardon, DDS

Title

Owner

Phone

(918) 998-0996

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1635120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635120000000",
    "number": "1386308492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 RIVERWALK TER STE 250",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740375619",
            "telephone_number": "918-998-0996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1629 POYNTZ AVE",
            "city": "MANHATTAN",
            "state": "KS",
            "postal_code": "665024148",
            "telephone_number": "785-776-1771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERALD DENTAL P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-25",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A",
        "authorized_official_last_name": "CARDON",
        "authorized_official_first_name": "CREED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-998-0996",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2021; 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.