Active NPI
Alexis Kennedy, DMD
- Prosthodontics
- Avondale, AZ
National Provider Identifier
1679343677
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- D011600
- Practice address
- 9915 W McDowell Rd Ste 106
Avondale, AZ 85392-4897 - Phone
- (623) 907-4562
- NPI assigned
- Jan 2, 2024
- Last updated
- Oct 7, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | D011600 | AZ | Primary |
Addresses
Primary practice location
9915 W McDowell Rd Ste 106
Avondale, AZ 85392-4897
Mailing address
9915 W McDowell Rd Ste 106
Avondale, AZ 85392-4897
Other practice location 1
10555 N Tatum Blvd Ste A104
Paradise Valley, AZ 85253-1096
Phone (480) 806-1223
Other names 1
- Alexis Pawlak
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240529000319 | AZ | Order and Referring Only - Dentist | 8022450626 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gateway Dental Group, LLP | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Gateway Dental Group
- General Practice Dentistry
- Avondale, AZ
- NPI 1992834121
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1704153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728259200000",
"number": "1679343677",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9915 W MCDOWELL RD STE 106",
"city": "AVONDALE",
"state": "AZ",
"postal_code": "853924897"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9915 W MCDOWELL RD STE 106",
"city": "AVONDALE",
"state": "AZ",
"postal_code": "853924897",
"telephone_number": "623-907-4562"
}
],
"practiceLocations": [
{
"address_1": "10555 N Tatum Blvd Ste A104",
"address_purpose": "LOCATION",
"city": "Paradise Valley",
"state": "AZ",
"postal_code": "852531096",
"country_code": "US",
"telephone_number": "480-806-1223",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KENNEDY",
"first_name": "ALEXIS",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-01-02",
"last_updated": "2024-10-07",
"certification_date": "2024-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "AZ",
"license": "D011600",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "ALEXIS",
"last_name": "PAWLAK",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Avondale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2024; 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.