Active NPI
Kriss L Childress, RDH
- Dental Hygienist
- Pueblo, CO
National Provider Identifier
1881730596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 3009
- Practice address
- 1407 West 29TH St
Pueblo, CO 81008 - Phone
- (719) 546-0404
- Fax
- (719) 546-0408
- NPI assigned
- Jan 29, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 3009 | CO | Primary |
Addresses
Primary practice location
1407 West 29TH St
Pueblo, CO 81008
Mailing address
1407 West 29TH St
Pueblo, CO 81008
Phone (719) 546-0404
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 61938742 | Medicaid | CO |
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 |
|---|---|---|---|
| 3009 | CO | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881730596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1407 WEST 29TH ST",
"city": "PUEBLO",
"state": "CO",
"postal_code": "81008",
"telephone_number": "719-546-0404",
"fax_number": "719-546-0408"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1407 WEST 29TH ST",
"city": "PUEBLO",
"state": "CO",
"postal_code": "81008",
"telephone_number": "719-546-0404",
"fax_number": "719-546-0408"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHILDRESS",
"first_name": "KRISS",
"middle_name": "L",
"name_prefix": "Mr.",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "CO",
"license": "3009",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "61938742",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.