Danesa Khomenko, RDH

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

1119 Issued in MT

Practice address

210 Dixon Ave
Missoula, MT 59801-8722

Phone

(406) 370-5024

NPI assigned

May 19, 2023

Sex

Female

Sole proprietor

No

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

State licenses

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

{
    "created_epoch": "1684454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684454400000",
    "number": "1427749357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 DIXON AVE",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598018722",
            "telephone_number": "406-370-5024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 DIXON AVE",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598018722",
            "telephone_number": "406-370-5024"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "830 W Central Ave",
            "address_purpose": "LOCATION",
            "city": "Missoula",
            "state": "MT",
            "postal_code": "598017931",
            "country_code": "US",
            "telephone_number": "406-370-5024",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "830 W Central Ave",
            "address_purpose": "LOCATION",
            "city": "Missoula",
            "state": "MT",
            "postal_code": "598017931",
            "country_code": "US",
            "telephone_number": "406-829-9515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHOMENKO",
        "first_name": "DANESA",
        "credential": "RDH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-19",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "MT",
            "license": "1119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Shayna Rae Killam, RPH, PHARMD

• Dental Hygienist in Missoula, MT
• Providers in Missoula, MT by specialty
• Dental Hygienist in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 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.