Active NPI
Kenneth Evins, DENTIST
- General Practice Dentistry
- Louisburg, NC
National Provider Identifier
1386780328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4636
- Practice address
- 107 Industrial Drive
Suite C
Louisburg, NC 27549 - Phone
- (919) 496-8132
- Fax
- (919) 496-3123
- NPI assigned
- Jan 29, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4636 | NC | Primary |
Addresses
Primary practice location
107 Industrial Drive
Suite C
Louisburg, NC 27549
Mailing address
107 Industrial Drive
Suite C
Louisburg, NC 27549
Phone (919) 496-8132
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07101 | Other | NC | HEALTH CHOICE |
| 3404486 | Medicaid | NC | |
| 81111D | Other | NC | PRIVATE INS |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1386780328",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 INDUSTRIAL DRIVE",
"address_2": "SUITE C",
"city": "LOUISBURG",
"state": "NC",
"postal_code": "27549",
"telephone_number": "919-496-8132",
"fax_number": "919-496-3123"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 INDUSTRIAL DRIVE",
"address_2": "SUITE C",
"city": "LOUISBURG",
"state": "NC",
"postal_code": "27549",
"telephone_number": "919-496-8132",
"fax_number": "919-496-3123"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVINS",
"first_name": "KENNETH",
"name_prefix": "Mr.",
"credential": "DENTIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "4636",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH CHOICE",
"identifier": "07101",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3404486",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIVATE INS",
"identifier": "81111D",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Louisburg, NC
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.