Active NPI
Kate Agnes Kragenbrink, DDS
- General Practice Dentistry
- Waterloo, IA
National Provider Identifier
1508544198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DDS-10112
- Practice address
- 4015 Hurst Dr
Waterloo, IA 50701-9035 - Phone
- (319) 235-6287
- NPI assigned
- Jul 5, 2023
- Sex
- Female
- 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 | DDS-10112 | IA | Primary |
Addresses
Primary practice location
4015 Hurst Dr
Waterloo, IA 50701-9035
Mailing address
4015 Hurst Dr
Waterloo, IA 50701-9035
Phone (319) 235-6287
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DDS-10112 | IA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1688515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688515200000",
"number": "1508544198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4015 HURST DR",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507019035",
"telephone_number": "319-235-6287"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4015 HURST DR",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507019035",
"telephone_number": "319-235-6287"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRAGENBRINK",
"first_name": "KATE",
"middle_name": "AGNES",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-05",
"last_updated": "2023-07-05",
"certification_date": "2023-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IA",
"license": "DDS-10112",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterloo, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 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.