NPIMap

Organization Active NPI

Kevin M Allred DDS PC

  • General Practice Dentistry
  • Big Stone Gap, VA
National Provider Identifier
1902490840
Registry record updated Aug 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
KEVIN M ALLRED DDS PC
Practice address
407 3Rd Ave E
Big Stone Gap, VA 24219-2365
Phone
(276) 523-0931
Fax
(276) 523-0932
NPI assigned
Feb 22, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2021

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

Authorized official

Name
Samantha Allred
Title
Secretary
Phone
(760) 807-6632

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

407 3Rd Ave E
Big Stone Gap, VA 24219-2365

Mailing address

407 3Rd Ave E
Big Stone Gap, VA 24219-2365
Phone (276) 523-0931

Other identifiers 1

IdentifierTypeStateIssuer
1679834287OtherVADENTAL

Other names 1

  • Powell Valley Dental Doing business as

National Provider Directory

National Provider Directory

Locations

407 3rd Ave E
Big Stone Gap, VA 24219
Phone (276) 523-0931

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1613952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628121600000",
    "number": "1902490840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 3RD AVE E",
            "city": "BIG STONE GAP",
            "state": "VA",
            "postal_code": "242192365",
            "telephone_number": "276-523-0931",
            "fax_number": "276-523-0932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 3RD AVE E",
            "city": "BIG STONE GAP",
            "state": "VA",
            "postal_code": "242192365",
            "telephone_number": "276-523-0931",
            "fax_number": "276-523-0932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN M ALLRED DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-22",
        "last_updated": "2021-08-05",
        "certification_date": "2021-07-26",
        "status": "A",
        "authorized_official_last_name": "ALLRED",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "760-807-6632"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL",
            "identifier": "1679834287",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Powell Valley Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Powell Valley Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Big Stone Gap, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 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.