Individual provider Active NPI

Gwendolyn Dawn Kines-McLeod, D.D.S.

  • General Practice Dentistry
  • Terrell, TX
National Provider Identifier
1730270703
Registry record updated Oct 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
22185 Issued in TX
Practice address
401 N Ann St
B
Terrell, TX 75160-2549
Phone
(972) 524-5347
Fax
(972) 524-2142
NPI assigned
Sep 27, 2006
Last updated
Oct 30, 2017By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 30, 2017

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 22185 TX Primary

Addresses

Primary practice location

401 N Ann St
B
Terrell, TX 75160-2549

Mailing address

401 N Ann St Ste B
Terrell, TX 75160-2549
Phone (972) 524-5347

Other identifiers 1

IdentifierTypeStateIssuer
1784944-01MedicaidTX

Other names 1

  • Dr. Gwendolyn Dawn Kines Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20150708002440 TX Order and Referring Only - DentistPractitioner - Dentist 1355653130

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Gwendolyn Kines-McLeod DDS,PLLC General Practice CurrentSince Nov 1, 2020 Accepting new patients

Locations

401 N Ann St
Ste B
Terrell, TX 75160
Phone (972) 524-5347

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.

NPI Registry JSON

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509321600000",
    "number": "1730270703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 N ANN ST STE B",
            "city": "TERRELL",
            "state": "TX",
            "postal_code": "751602549",
            "telephone_number": "972-524-5347",
            "fax_number": "972-524-2142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 N ANN ST",
            "address_2": "B",
            "city": "TERRELL",
            "state": "TX",
            "postal_code": "751602549",
            "telephone_number": "972-524-5347",
            "fax_number": "972-524-2142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINES-MCLEOD",
        "first_name": "GWENDOLYN",
        "middle_name": "DAWN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2017-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "22185",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1784944-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GWENDOLYN",
            "last_name": "KINES",
            "middle_name": "DAWN",
            "prefix": "DR.",
            "credential": "D.D.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Terrell, TX

Sources for this page

Verify at the official NPI Registry.