Shawn Patrick Kelly, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22DI02260700 Issued in NJ

Practice address

13 Somerdale SQ
Somerdale, NJ 08083-1345

Phone

(856) 566-6969

Fax

(856) 566-6012

NPI assigned

Nov 22, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Rutgers School of Dental Medicine

  • Dental Clinic/Center
  • Somerdale, NJ
  • NPI 1831302504
  NPD (past)

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369785600000",
    "number": "1013082189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "182 WHITE CEDAR DR",
            "city": "SICKLERVILLE",
            "state": "NJ",
            "postal_code": "080813409",
            "telephone_number": "609-707-1032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 SOMERDALE SQ",
            "city": "SOMERDALE",
            "state": "NJ",
            "postal_code": "080831345",
            "telephone_number": "856-566-6969",
            "fax_number": "856-566-6012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SHAWN",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-22",
        "last_updated": "2013-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI02260700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Hood, RN
• Charles James Idler, ED.D.
• Integrity Family Solutions
• Diana Neal Juelg, APN
• Vijay K Kalola, M.D.
• Kennedy University Hospital, Inc
• Kennedy University Hospital, Inc.
• Kennedy University Hospitals
• David Jay Kirstein, D.C.
• Christine Klenk, ATC, CSCS

• General Practice Dentistry in Somerdale, NJ
• Providers in Somerdale, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.