NPIMap

Organization Active NPI

Kenneth W Childress DDS PC

  • General Practice Dentistry
  • Ruidoso, NM
National Provider Identifier
1982913935
Registry record updated Mar 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2704 Issued in NM
Legal business name
KENNETH W CHILDRESS DDS PC
Practice address
721 Mechem Dr
Sierra Mall #5
Ruidoso, NM 88345-6911
Phone
(575) 257-0246
NPI assigned
Sep 24, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2012

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

Authorized official

Name
Kenneth Childress, DDSNPI 1912923475
Title
President
Phone
(719) 671-7369

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 2704 NM Primary

Addresses

Primary practice location

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

Mailing address

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

National Provider Directory

National Provider Directory

Locations

721 Mechem Dr
Ste 5
Ruidoso, NM 88345
Phone (505) 257-0246

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1285286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331683200000",
    "number": "1982913935",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH W CHILDRESS DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-24",
        "last_updated": "2012-03-14",
        "status": "A",
        "authorized_official_last_name": "CHILDRESS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "719-671-7369",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "2704",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ruidoso, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 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.