NPIMap

Individual provider Active NPI

Krystina Lee Ann Sandefur, DMD

  • General Practice Dentistry
  • Paris, KY
National Provider Identifier
1912490251
Registry record updated Jun 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
10113 Issued in KY
Practice address
2115 Rocky Dr
Paris, KY 40361-1370
Phone
(859) 987-3290
Fax
(859) 987-6800
NPI assigned
Jun 12, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 12, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 10113 KY Primary

Addresses

Primary practice location

2115 Rocky Dr
Paris, KY 40361-1370

Mailing address

2115 Rocky Dr
Paris, KY 40361-1370
Phone (859) 987-3290

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

LicenseStateTypeSpecialty
10113KYMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Cynthiana Dental Center General Practice Past Accepting new patients
Dental Health Associates PSC General Practice Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1528761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528761600000",
    "number": "1912490251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2115 ROCKY DR",
            "city": "PARIS",
            "state": "KY",
            "postal_code": "403611370",
            "telephone_number": "859-987-3290",
            "fax_number": "859-987-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 ROCKY DR",
            "city": "PARIS",
            "state": "KY",
            "postal_code": "403611370",
            "telephone_number": "859-987-3290",
            "fax_number": "859-987-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDEFUR",
        "first_name": "KRYSTINA",
        "middle_name": "LEE ANN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-12",
        "last_updated": "2018-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "10113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paris, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2018; 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.