Active NPI
Kristin H Kenner, D.D.S.
- General Practice Dentistry
- Devils Lake, ND
National Provider Identifier
1609089085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 1736
- Practice address
- 501 5TH Ave SE
Devils Lake, ND 58301-3621 - Phone
- (701) 662-4141
- Fax
- (701) 662-7582
- NPI assigned
- May 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 1736 | ND | Primary |
Addresses
Primary practice location
501 5TH Ave SE
Devils Lake, ND 58301-3621
Mailing address
501 5TH Ave SE
Devils Lake, ND 58301-3621
Phone (701) 662-4141
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1736 | Other | ND | STATE LICENSE NUMBER |
| 842354 | Other | ND | UNITED CONCORDIA INS |
| 901736 | Other | ND | DENTAL SERVICE CORP ID |
| 40953 | Medicaid | ND |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bristol Bay Area Health Corporation | Current | Accepting new patients | |
| Kenner Family Dentistry | Current | Accepting new patients |
Locations
501 5th Ave SE
Devils Lake, ND 58301
Phone (701) 662-4141
Interoperability endpoints
- khkenner@direct.bbahc.org
Organizations & group practices 2
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.
-
- Dental Clinic/Center
- Devils Lake, ND
- NPI 1568146892
-
- Medicare Defined Swing Bed Hospital Unit
- Dillingham, AK
- NPI 1770645202
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609089085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 5TH AVE SE",
"city": "DEVILS LAKE",
"state": "ND",
"postal_code": "583013621",
"telephone_number": "701-662-4141",
"fax_number": "701-662-7582"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 5TH AVE SE",
"city": "DEVILS LAKE",
"state": "ND",
"postal_code": "583013621",
"telephone_number": "701-662-4141",
"fax_number": "701-662-7582"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNER",
"first_name": "KRISTIN",
"middle_name": "H",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "ND",
"license": "1736",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "1736",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA INS",
"identifier": "842354",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL SERVICE CORP ID",
"identifier": "901736",
"state": "ND"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40953",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Devils Lake, ND
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.