Individual provider Active NPI

Kathryn Dundervill McKown, DMD

  • Pediatric Dentistry
  • Raleigh, NC
National Provider Identifier
1669097143
Registry record updated Feb 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
12624 Issued in NC
Practice address
7401 Creedmoor Rd
Raleigh, NC 27613-1640
Phone
(919) 719-1780
NPI assigned
Jun 10, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 0442000383 VA
Pediatric Dentistry 1223P0221X 12624 NC Primary
Dentist 122300000X 12624 NC

Addresses

Primary practice location

7401 Creedmoor Rd
Raleigh, NC 27613-1640

Mailing address

626 E Whitaker ML Rd
Raleigh, NC 27608-2636

Other practice location 1

520 N 12th St
Richmond, VA 23298-5064
Phone (804) 828-9190

Other practice location 2

100 Health Park Dr Ste 100
Garner, NC 27529-6994
Phone (919) 719-1780

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

LicenseStateTypeSpecialty
12624NCMDDentist
0442000383VAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Macon, Collie, Pretzer, Kornstein and Hicks DDS Pediatric Dentistry CurrentSince Oct 8, 2023 Accepting new patients

Locations

7401 Creedmoor Rd
Raleigh, NC 27613
Phone (919) 622-2035

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1591747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770595200000",
    "number": "1669097143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "626 E WHITAKER ML RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276082636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7401 CREEDMOOR RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276131640",
            "telephone_number": "919-719-1780"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "520 N 12th St",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "VA",
            "postal_code": "232985064",
            "country_code": "US",
            "telephone_number": "804-828-9190",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Health Park Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Garner",
            "state": "NC",
            "postal_code": "275296994",
            "country_code": "US",
            "telephone_number": "919-719-1780",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKOWN",
        "first_name": "KATHRYN",
        "middle_name": "DUNDERVILL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-10",
        "last_updated": "2026-02-09",
        "certification_date": "2026-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "VA",
            "license": "0442000383",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NC",
            "license": "12624",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "12624",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2026; 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.