NPIMap

Organization Active NPI

First Avenue Dental, P.a.

Doing business as First Dental

  • General Practice Dentistry
  • Dodge City, KS
National Provider Identifier
1861788960
Registry record updated Aug 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
FIRST AVENUE DENTAL, P.A.
Doing business as
First Dental
Practice address
2306 1St Ave
Dodge City, KS 67801-2527
Phone
(620) 371-6630
Fax
(620) 371-6631
NPI assigned
Jun 27, 2011
Last updated
Aug 19, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2021

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

Authorized official

Name
Mrs. Jesicka J Wilkinson
Title
Administration
Phone
(620) 225-5154

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

2306 1St Ave
Dodge City, KS 67801-2527

Mailing address

2306 1St Ave
Dodge City, KS 67801-2527
Phone (620) 225-5154

Other practice location 1

23 E 11th St
Liberal, KS 67901-2720
Phone (620) 604-9279

Other identifiers 2

IdentifierTypeStateIssuer
201223110AMedicaidKS
200867320AMedicaidKS

Other names 1

  • First Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
First Avenue Dental PA3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2306 1st Ave
Dodge City, KS 67801
Phone (620) 225-5154

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1309132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629331200000",
    "number": "1861788960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2306 1ST AVE",
            "city": "DODGE CITY",
            "state": "KS",
            "postal_code": "678012527",
            "telephone_number": "620-225-5154",
            "fax_number": "620-371-8870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2306 1ST AVE",
            "city": "DODGE CITY",
            "state": "KS",
            "postal_code": "678012527",
            "telephone_number": "620-371-6630",
            "fax_number": "620-371-6631"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "23 E 11th St",
            "address_purpose": "LOCATION",
            "city": "Liberal",
            "state": "KS",
            "postal_code": "679012720",
            "country_code": "US",
            "telephone_number": "620-604-9279",
            "fax_number": "620-417-9616",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FIRST AVENUE DENTAL, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-27",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A",
        "authorized_official_last_name": "WILKINSON",
        "authorized_official_first_name": "JESICKA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ADMINISTRATION",
        "authorized_official_telephone_number": "620-225-5154",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201223110A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200867320A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "First Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dodge City, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.