Kenneth Childress, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2704 Issued in NM

Practice address

721 Mechem Dr
Sierra Mall #5
Ruidoso, NM 88345-6911

Phone

(575) 257-0246

Fax

(575) 257-0249

NPI assigned

Jul 15, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Kenneth W Childress DDS PC

  • General Practice Dentistry
  • Ruidoso, NM
  • NPI 1982913935
  NPD (past) Authorized official

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335225600000",
    "number": "1912923475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 MECHEM DR",
            "address_2": "SIERRA MALL #5",
            "city": "RUIDOSO",
            "state": "NM",
            "postal_code": "883456911",
            "telephone_number": "575-257-0246",
            "fax_number": "575-257-0249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 MECHEM DR",
            "address_2": "SIERRA MALL #5",
            "city": "RUIDOSO",
            "state": "NM",
            "postal_code": "883456911",
            "telephone_number": "575-257-0246",
            "fax_number": "575-257-0249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHILDRESS",
        "first_name": "KENNETH",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-15",
        "last_updated": "2012-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "8164",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "2704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "88284751",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sara Leslie Chapman, LSAA
• Angela Louise Chavez, PTA
• Jackie Chavez
• Jaden N Chavez
• Childrens Dental Clinic of Ruidoso PC
• Charlotte Arlene Christopher, RN
• Terry Rustyn Christopher
• Michael P Clements, M.D.
• Clinical Counseling, Rebekah Stephens LLC
• Marjorie Marie Coen

• General Practice Dentistry in Ruidoso, NM
• Providers in Ruidoso, NM by specialty
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 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.

Verify at the official NPI Registry.