Active NPI
Kendall Abraham Dekreek, DDS
- Dentist
- Rohnert Park, CA
National Provider Identifier
1619680170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DDS107893
- Practice address
- 6230 State Farm Dr
Rohnert Park, CA 94928-2120 - Phone
- (707) 795-4523
- Fax
- (707) 586-1650
- NPI assigned
- Dec 29, 2022
- 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 | DDS107893 | CA | Primary |
Addresses
Primary practice location
6230 State Farm Dr
Rohnert Park, CA 94928-2120
Mailing address
9048 Brooks Rd S
PMB 167
Windsor, CA 95492-7811
Phone (805) 657-2487
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 |
|---|---|---|---|
| DDS107893 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1672272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672272000000",
"number": "1619680170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9048 BROOKS RD S",
"address_2": "PMB 167",
"city": "WINDSOR",
"state": "CA",
"postal_code": "954927811",
"telephone_number": "805-657-2487"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6230 STATE FARM DR",
"city": "ROHNERT PARK",
"state": "CA",
"postal_code": "949282120",
"telephone_number": "707-795-4523",
"fax_number": "707-586-1650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEKREEK",
"first_name": "KENDALL",
"middle_name": "ABRAHAM",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-12-29",
"last_updated": "2022-12-29",
"certification_date": "2022-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "DDS107893",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rohnert Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.