Kim E Diefenderfer, DMD, MS, MS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS027331L Issued in PA

Practice address

1121 W Michigan St
Indianapolis, IN 46202-5211

Phone

(172) 743-7153

NPI assigned

Feb 8, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636329600000",
    "number": "1932172459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2728 STILL CREEK DR",
            "city": "ZIONSVILLE",
            "state": "IN",
            "postal_code": "460771195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 W MICHIGAN ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025211",
            "telephone_number": "172-743-7153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIEFENDERFER",
        "first_name": "KIM",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DMD, MS, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-08",
        "last_updated": "2021-11-08",
        "certification_date": "2021-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12012261A",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS027331L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie A Didyk-Horine, NP
• Elizabeth Ann Dieckmann, PMHNP
• Chris Diederich, LCSW
• Benjamin Diedring, DO
• Tori Nicole Diedring, DO
• Allan O Diefendorf, PH.D.
• Robert E Diegel, O.D.
• Annmarie Diekhoff
• Lauren Diekhoff
• Nicole R Diekhoff

• General Practice Dentistry in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 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.