Active NPI
Kenneth John Eganhouse, D.D.S., M.S.
- Periodontics
- Ottumwa, IA
National Provider Identifier
1386772085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 7194
- Practice address
- 227 W 4TH St
Suite 2C
Ottumwa, IA 52501-2544 - Phone
- (641) 684-0215
- NPI assigned
- Mar 2, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 7194 | IA | Primary |
Addresses
Primary practice location
227 W 4TH St
Suite 2C
Ottumwa, IA 52501-2544
Mailing address
1636 Plum Thicket LN
West Des Moines, IA 50266-6603
Phone (515) 222-2627
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7194 | IA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1386772085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1636 PLUM THICKET LN",
"city": "WEST DES MOINES",
"state": "IA",
"postal_code": "502666603",
"telephone_number": "515-222-2627"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "227 W 4TH ST",
"address_2": "SUITE 2C",
"city": "OTTUMWA",
"state": "IA",
"postal_code": "525012544",
"telephone_number": "641-684-0215"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EGANHOUSE",
"first_name": "KENNETH",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "D.D.S., M.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "IA",
"license": "7194",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ottumwa, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.