Active NPI
John D Gagnon, DDS
- Oral & Maxillofacial Surgery (D.M.D.)
- Wichita, KS
National Provider Identifier
1619911641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral & Maxillofacial Surgery (D.M.D.)
- License
- 6850
- Practice address
- 3510 N Ridge Rd
Ste 500
Wichita, KS 67205-1224 - Phone
- (316) 722-0800
- Fax
- (316) 722-5822
- NPI assigned
- Jun 16, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 6850 | KS | |
| Oral & Maxillofacial Surgery (D.M.D.) | 204E00000X | 6850 | KS | Primary |
Addresses
Primary practice location
3510 N Ridge Rd
Ste 500
Wichita, KS 67205-1224
Mailing address
3510 N Ridge Rd
Ste 500
Wichita, KS 67205-1224
Phone (316) 722-0800
Other practice location 1
10111 E 21st St N
Wichita, KS 67206-3508
Phone (316) 722-0800
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 116677 | Other | KS | BCBS OF KS |
| 974027 | Other | UNITED CONCORDIA | |
| 100317420A | Medicaid | KS |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6850 | KS | MD | Oral & Maxillofacial Surgery (D.M.D.) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1573516800000",
"number": "1619911641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3510 N RIDGE RD",
"address_2": "STE 500",
"city": "WICHITA",
"state": "KS",
"postal_code": "672051224",
"telephone_number": "316-722-0800",
"fax_number": "316-722-5822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3510 N RIDGE RD",
"address_2": "STE 500",
"city": "WICHITA",
"state": "KS",
"postal_code": "672051224",
"telephone_number": "316-722-0800",
"fax_number": "316-722-5822"
}
],
"practiceLocations": [
{
"address_1": "10111 E 21st St N",
"address_purpose": "LOCATION",
"city": "Wichita",
"state": "KS",
"postal_code": "672063508",
"country_code": "US",
"telephone_number": "316-722-0800",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GAGNON",
"first_name": "JOHN",
"middle_name": "D",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-16",
"last_updated": "2019-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "KS",
"license": "6850",
"primary": false
},
{
"code": "204E00000X",
"taxonomy_group": "",
"desc": "Oral & Maxillofacial Surgery",
"state": "KS",
"license": "6850",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF KS",
"identifier": "116677",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "974027",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100317420A",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wichita, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.