Austin Rodenberg, DMD, MSD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

10612 Issued in KY

Practice address

6400 Westwind Way Ste C
Crestwood, KY 40014-6773

Phone

(502) 754-6633

Fax

(859) 207-5102

NPI assigned

May 19, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Elm Pediatric Dentistry of Northern Kentucky PLLC

  • Pediatric Dentistry
  • Independence, KY
  • NPI 1992505739
  NPD Authorized official
• Elm Pediatric Dentistry, PLLC

  • Pediatric Dentistry
  • Crestwood, KY
  • NPI 1578255055
  NPD Authorized official
• Kentucky Tongue-Tie Center LLC

  • Pediatric Dentistry
  • Crestwood, KY
  • NPI 1629828470
  NPD Authorized official
• Commission for Children With Special Health Car

  • Public Health or Welfare Agency
  • Louisville, KY
  • NPI 1831197953
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684800000000",
    "number": "1649844069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "934 WOODLAND RIDGE CIR",
            "city": "LA GRANGE",
            "state": "KY",
            "postal_code": "400311373",
            "telephone_number": "270-572-9309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6400 WESTWIND WAY STE C",
            "city": "CRESTWOOD",
            "state": "KY",
            "postal_code": "400146773",
            "telephone_number": "502-754-6633",
            "fax_number": "859-207-5102"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "934 Woodland Ridge Cir",
            "address_purpose": "LOCATION",
            "city": "LA Grange",
            "state": "KY",
            "postal_code": "400311373",
            "country_code": "US",
            "telephone_number": "270-572-9309",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RODENBERG",
        "first_name": "AUSTIN",
        "name_prefix": "Dr.",
        "credential": "DMD, MSD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-19",
        "last_updated": "2023-05-23",
        "certification_date": "2023-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "10612",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "KY",
            "license": "10612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrie Rice, PT
• Krista Alison Rice, MA, CCC-SLP
• Austin Hancock Roberts, M.S.
• Pierce Roberts, BCBA
• Mary Leslie Robinson, SLP
• Anne Therese Rogers, MOT OTR/L
• Brooke Michelle Raque Rohrs
• Douglas Richard Rosencrans
• Leslie Marie Ruiz
• Elizabeth Behr Runyon, APRN

• Pediatric Dentistry in Crestwood, KY
• Providers in Crestwood, KY by specialty
• Pediatric Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.