Active NPI
Jourdan Lynne Kilthau
- Dentist
- Fort Belvoir, VA
National Provider Identifier
1669043352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 9974
- Practice address
- 9225 Doerr Rd # 1220
Fort Belvoir, VA 22060-2204 - Phone
- (571) 231-6056
- NPI assigned
- Jul 5, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 9974 | SC | Primary |
Addresses
Primary practice location
9225 Doerr Rd # 1220
Fort Belvoir, VA 22060-2204
Mailing address
111 Brickworks Dr Apt 1209
Cayce, SC 29033-4432
Phone (573) 528-2426
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9974 | SC | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727827200000",
"number": "1669043352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 BRICKWORKS DR APT 1209",
"city": "CAYCE",
"state": "SC",
"postal_code": "290334432",
"telephone_number": "573-528-2426"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9225 DOERR RD # 1220",
"city": "FORT BELVOIR",
"state": "VA",
"postal_code": "220602204",
"telephone_number": "571-231-6056"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KILTHAU",
"first_name": "JOURDAN",
"middle_name": "LYNNE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-05",
"last_updated": "2024-10-02",
"certification_date": "2024-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SC",
"license": "9974",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Belvoir, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.