Active NPI
Kenneth Edmund Arnold, DDS
- Dentist
- Yelm, WA
National Provider Identifier
1609977396
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE00004154
- Practice address
- 607 Yelm Avenue West
Yelm, WA 98597-5130 - Phone
- (360) 458-7785
- Fax
- (360) 458-7785
- NPI assigned
- Sep 26, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DE00004154 | WA | Primary |
Addresses
Primary practice location
607 Yelm Avenue West
Yelm, WA 98597-5130
Mailing address
PO Box 5130
Yelm, WA 98597-5130
Phone (360) 458-7785
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5002126 | Medicaid | WA |
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 |
|---|---|---|---|
| DE00004154 | WA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609977396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5130",
"city": "YELM",
"state": "WA",
"postal_code": "985975130",
"telephone_number": "360-458-7785",
"fax_number": "360-458-7785"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "607 YELM AVENUE WEST",
"city": "YELM",
"state": "WA",
"postal_code": "985975130",
"telephone_number": "360-458-7785",
"fax_number": "360-458-7785"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ARNOLD",
"first_name": "KENNETH",
"middle_name": "EDMUND",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE00004154",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5002126",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Yelm, WA
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.