Kyle Joseph Fonken, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DDS-09556 Issued in IA

Practice address

415 E Coolbaugh St
Red Oak, IA 51566-2319

Phone

(712) 623-3383

NPI assigned

Jun 25, 2018

Last updated

Jun 25, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dental Care, PC

  • General Practice Dentistry
  • Red Oak, IA
  • NPI 1316088396
  NPD (past)

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

{
    "created_epoch": "1529884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529884800000",
    "number": "1659866531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 S 38TH ST APT 203",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515013385",
            "telephone_number": "208-921-6211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 E COOLBAUGH ST",
            "city": "RED OAK",
            "state": "IA",
            "postal_code": "515662319",
            "telephone_number": "712-623-3383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONKEN",
        "first_name": "KYLE",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-25",
        "last_updated": "2018-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "DDS-09556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniela M Donoso Pena, MD
• Ava Dorrance, MSW, LISW
• Dr. Robert H. Sharp, P.C. (Family Vision Center)
• Patricia Anderson Dunbar, MSW
• Eye Care Associates of Co, LLC (Family Vision Center - Red Oak)
• Katherine Frericks, AU.D.
• Blake Friday, OTD
• Emily Kaye Furst, MS, RD, LD
• Terry J Gillespie, DDS
• Eduard Grass Garcia, MD

• General Practice Dentistry in Red Oak, IA
• Providers in Red Oak, IA by specialty
• General Practice Dentistry in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2018; 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.