Active NPI
Kenaysha Eshonji Gaddy, DDS
- Pediatric Dentistry
- Garner, NC
National Provider Identifier
1922116565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 7850
- Practice address
- 5638 NC Highway 42 W Ste 109
Garner, NC 27529-7998 - Phone
- (919) 772-1463
- NPI assigned
- Aug 25, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 7850 | NC | |
| Pediatric Dentistry | 1223P0221X | 7850 | NC | Primary |
Addresses
Primary practice location
5638 NC Highway 42 W Ste 109
Garner, NC 27529-7998
Mailing address
5638 NC Highway 42 W Ste 109
Garner, NC 27529-7998
Phone (919) 772-1463
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 89-045YU | Medicaid | NC | |
| 9026U | Other | BLUE CROSS BLUE SHIELD NC |
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 |
|---|---|---|---|
| 7850 | NC | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Michael a Derose DDS PA | General Practice | Past | Accepting new patients |
| Rafael Rivera, Jr., DDS, PLLC | 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.
-
- General Practice Dentistry
- Raleigh, NC
- NPI 1457389108
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716336000000",
"number": "1922116565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5638 NC HIGHWAY 42 W STE 109",
"city": "GARNER",
"state": "NC",
"postal_code": "275297998",
"telephone_number": "919-772-1463"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5638 NC HIGHWAY 42 W STE 109",
"city": "GARNER",
"state": "NC",
"postal_code": "275297998",
"telephone_number": "919-772-1463"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GADDY",
"first_name": "KENAYSHA",
"middle_name": "ESHONJI",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-25",
"last_updated": "2024-05-22",
"certification_date": "2024-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "7850",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NC",
"license": "7850",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "89-045YU",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD NC",
"identifier": "9026U",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Garner, NC
- Freedom Family Chiropractic, PLLC
- Fresenius Medical Care White Oak, LLC (Fresenius Medical Care White Oak)
- Fuller & Associates III, PA (Garner Family & Cosmetic Dentistry)
- Lance Robert Fuller, M.D.
- Kimberly Fusca
- Gahc3 Garner NC TRS Sub, LLC (Cadence Garner)
- Barbra Galavotti
- Marisa Galavotti
- Viviana Catherine Galindo Leon
- Karen Burns Gall, LCMHCS, NCC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.