Kirk Gerard Ellender, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

3822 Issued in LA

Practice address

2110 I 10 Service Rd
Suite #201
Kenner, LA 70065

Phone

(504) 443-3337

Fax

(504) 443-3337

NPI assigned

Apr 30, 2008

Last updated

Apr 30, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

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

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

{
    "created_epoch": "1209513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209513600000",
    "number": "1659546687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2110 I 10 SERVICE RD",
            "address_2": "SUITE #201",
            "city": "KENNER",
            "state": "LA",
            "postal_code": "70065",
            "telephone_number": "504-443-3337",
            "fax_number": "504-443-3337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2110 I 10 SERVICE RD",
            "address_2": "SUITE #201",
            "city": "KENNER",
            "state": "LA",
            "postal_code": "70065",
            "telephone_number": "504-443-3337",
            "fax_number": "504-443-3337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLENDER",
        "first_name": "KIRK",
        "middle_name": "GERARD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-30",
        "last_updated": "2008-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "LA",
            "license": "3822",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2008; 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.