NPIMap

Organization Active NPI

Ingersoll Dental Group PC

  • General Practice Dentistry
  • Des Moines, IA
National Provider Identifier
1659565349
Registry record updated Sep 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
08239 Issued in IA
Legal business name
INGERSOLL DENTAL GROUP PC
Practice address
3830 Ingersoll Ave
Des Moines, IA 50312-3413
Phone
(515) 274-5151
Fax
(515) 274-6259
NPI assigned
Sep 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2007

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

Authorized official

Name
Dr. Zachary Andrew Kouri, D.D.S.NPI 1174609846
Title
Partner
Phone
(515) 274-5151

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 08239 IA Primary

Addresses

Primary practice location

3830 Ingersoll Ave
Des Moines, IA 50312-3413

Mailing address

3830 Ingersoll Ave
Des Moines, IA 50312-3413
Phone (515) 274-5151

Other identifiers 2

IdentifierTypeStateIssuer
1480590MedicaidIA
1481259MedicaidIA

National Provider Directory

National Provider Directory

Locations

3830 Ingersoll Ave
Des Moines, IA 50312
Phone (515) 274-5151

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1188950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188950400000",
    "number": "1659565349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3830 INGERSOLL AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503123413",
            "telephone_number": "515-274-5151",
            "fax_number": "515-274-6259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3830 INGERSOLL AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503123413",
            "telephone_number": "515-274-5151",
            "fax_number": "515-274-6259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INGERSOLL DENTAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-05",
        "last_updated": "2007-09-05",
        "status": "A",
        "authorized_official_last_name": "KOURI",
        "authorized_official_first_name": "ZACHARY",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "515-274-5151",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "08239",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1480590",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1481259",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 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.

Verify at the official NPI Registry.