Kenneth Patrick McInnis, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6288 Issued in OR

Practice address

1791 NW 173Rd Ave Ste 130
Beaverton, OR 97006-5630

Phone

(503) 640-0395

NPI assigned

Jul 22, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698105600000",
    "number": "1427079623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1791 NW 173RD AVE STE 130",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970065630",
            "telephone_number": "503-640-0395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1791 NW 173RD AVE STE 130",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970065630",
            "telephone_number": "503-640-0395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCINNIS",
        "first_name": "KENNETH",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-22",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "6288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristopher M McGowan, CADC II, QMHA
• Paul Raymond McGown, PA-C
• Kathryn McGrath, LCSW
• Kelly McGreal
• Jessica McGrory, LMT
• Ashlee McKay, ATC
• Wendy McKee, LMT
• Rayme McKelvey
• Barbara Rae McKenna, RDH
• Rosemary Ann McKenna

• General Practice Dentistry in Beaverton, OR
• Providers in Beaverton, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2023; 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.