Kelly Catherine Bast, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

1188 Issued in AK

Practice address

3112 Airport Way Ste 1
Fairbanks, AK 99709-4768

Phone

(907) 452-1250

NPI assigned

Nov 30, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AK

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Fairbanks Dental Center LLC

  • Customized Equipment (DME)
  • Fairbanks, AK
  • NPI 1831550631

  Dentist

  NPD

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693958400000",
    "number": "1740358753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3112 AIRPORT WAY STE 1",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997094768",
            "telephone_number": "907-452-1250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3112 AIRPORT WAY STE 1",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997094768",
            "telephone_number": "907-452-1250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAST",
        "first_name": "KELLY",
        "middle_name": "CATHERINE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-30",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AK",
            "license": "1188",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AK",
            "license": "1188",
            "primary": false
        },
        {
            "code": "1223X2210X",
            "taxonomy_group": "",
            "desc": "Dentist, Orofacial Pain",
            "state": "AK",
            "license": "1188",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF ALASKA LIC.",
            "identifier": "1188",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristen Nicole Barton, LPC
• Angela M Bass
• John Browning Bass, MD
• Fred D Bast, DDS
• John P Bast, D.D.S
• Celina Batchelder
• Brianna Bates, MS CCC-SLP
• David B Bates, LPC
• Sha-Raya Lynn Bates
• Marcia Batiste

• All providers in Fairbanks, AK
• Oral and Maxillofacial Surgery (Dentist) in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; 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.

Verify at the official NPI Registry.