Joelle Prose, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

61523 Issued in KS

Practice address

618TH Dental Company
Unit # 15660, BLDG # P3020
Apo, AP 96271-5660

Phone

(050) 050-3337

NPI assigned

Aug 18, 2015

Last updated

Apr 25, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Antioch Dentistry PA

  dba Antioch Dentistry

  • General Practice Dentistry
  • Merriam, KS
  • NPI 1720490261
  NPD (past)
• Village Modern Dentistry, PA

  dba Village Modern Dentistry

  • Dentist
  • Prairie Village, KS
  • NPI 1780195768
  NPD (past)

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

{
    "created_epoch": "1439856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556150400000",
    "number": "1922474519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 CAISSON HILL RD",
            "address_2": "U.S. ARMY DENTAL ACTIVITY",
            "city": "FT RILEY",
            "state": "KS",
            "postal_code": "664427037",
            "telephone_number": "785-239-7241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "MIL",
            "address_1": "618TH DENTAL COMPANY",
            "address_2": "UNIT # 15660, BLDG # P3020",
            "city": "APO",
            "state": "AP",
            "postal_code": "962715660",
            "telephone_number": "050-050-3337"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7501 Mission Rd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Prairie Village",
            "state": "KS",
            "postal_code": "662084217",
            "country_code": "US",
            "telephone_number": "913-601-5016",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5754 Antioch Rd",
            "address_purpose": "LOCATION",
            "city": "Merriam",
            "state": "KS",
            "postal_code": "662022015",
            "country_code": "US",
            "telephone_number": "913-671-7066",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROSE",
        "first_name": "JOELLE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-18",
        "last_updated": "2019-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901021571",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KS",
            "license": "61523",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INSURANCE",
            "identifier": "1922474519",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2019; 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.