Active NPI
Keith Eskanos, DDS
- Dentist
- Prescott, AZ
National Provider Identifier
1821024449
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6419
- Practice address
- 3103 Clearwater Dr
Suite B
Prescott, AZ 86305-7165 - Phone
- (928) 237-6456
- Fax
- (928) 777-3209
- NPI assigned
- Jun 24, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 6419 | AZ | Primary |
Addresses
Primary practice location
3103 Clearwater Dr
Suite B
Prescott, AZ 86305-7165
Mailing address
3103 Clearwater Dr
Suite B
Prescott, AZ 86305-7165
Phone (928) 237-6456
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 920315 | Medicaid | AZ | |
| AZ0415100 | Other | AZ | BLUE CROSS BLUE SHIELD |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 6419 | AZ | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348704000000",
"number": "1821024449",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3103 CLEARWATER DR",
"address_2": "SUITE B",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "863057165",
"telephone_number": "928-237-6456",
"fax_number": "928-777-3209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3103 CLEARWATER DR",
"address_2": "SUITE B",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "863057165",
"telephone_number": "928-237-6456",
"fax_number": "928-777-3209"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ESKANOS",
"first_name": "KEITH",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-24",
"last_updated": "2012-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "6419",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "920315",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "AZ0415100",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Prescott, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.