Kevin Mamoottil Thomas

Primary specialty

DentistTaxonomy code 122300000X

License

D012634 Issued in AZ

Practice address

10 W Adams St
Phoenix, AZ 85003-2025

Phone

(602) 207-8528

NPI assigned

Nov 2, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• KG1 PLLC

  • General Practice Dentistry
  • Phoenix, AZ
  • NPI 1265308753
  NPD (past)

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

{
    "created_epoch": "1667347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773100800000",
    "number": "1497462147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1727 E PECOS RD APT 4079",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852951879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 W ADAMS ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850032025",
            "telephone_number": "602-207-8528"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "760 Broadway",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112065317",
            "country_code": "US",
            "telephone_number": "718-963-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "KEVIN",
        "middle_name": "MAMOOTTIL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-11-02",
        "last_updated": "2026-03-10",
        "certification_date": "2026-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D012634",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "063927",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Josellin Alexis Thomas, MA
• Jourdan D Thomas
• Karina Thomas, OTR/L
• Keanne Thomas
• Kenneth Thomas
• Kimberly Thomas
• Kristine Thomas, DMD
• Latrice Yvonne Thomas, RN
• Lawrence Thomas
• Leslie Francis Thomas, M.D.

• Dentist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2026; 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.