Individual provider Active NPI

James Kernik, D.D.S.

  • General Practice Dentistry
  • Falcon Heights, MN
National Provider Identifier
1720148372
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
9351 Issued in MN
Practice address
1549 Larpenteur Ave W
Falcon Heights, MN 55113-6316
Phone
(651) 646-0412
Fax
(651) 646-8488
NPI assigned
Dec 12, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 9351 MN Primary

Addresses

Primary practice location

1549 Larpenteur Ave W
Falcon Heights, MN 55113-6316

Mailing address

1549 Larpenteur Ave W
Falcon Heights, MN 55113-6316
Phone (651) 646-0412

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160820000159 MN Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 3779878434

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9351MNMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720148372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1549 LARPENTEUR AVE W",
            "city": "FALCON HEIGHTS",
            "state": "MN",
            "postal_code": "551136316",
            "telephone_number": "651-646-0412",
            "fax_number": "651-646-8488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1549 LARPENTEUR AVE W",
            "city": "FALCON HEIGHTS",
            "state": "MN",
            "postal_code": "551136316",
            "telephone_number": "651-646-0412",
            "fax_number": "651-646-8488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERNIK",
        "first_name": "JAMES",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "9351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Falcon Heights, MN

Sources for this page

Verify at the official NPI Registry.