Paul Kellum, DDS

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

10931 Issued in FL

Legal business name

PAUL KELLUM, DDS

Practice address

985 Airport Rd
Destin, FL 32541-2835

Phone

(850) 837-6645

Fax

(850) 650-8553

NPI assigned

Jul 7, 2014

Last updated

Jul 7, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Henry Paul Kellum, D.D.S.NPI 1780753673

Title

Owner

Phone

(850) 837-6645

Specialties & licenses 1

Addresses

Other names 1

• Destin Dental Center Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Henry Paul Kellum, D.D.S.

  • General Practice Dentistry
  • Destin, FL
  • NPI 1780753673
  NPD (past) Authorized official

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

{
    "created_epoch": "1404691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404691200000",
    "number": "1033525431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "985 AIRPORT RD",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325412835",
            "telephone_number": "850-837-6645",
            "fax_number": "850-650-8553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "985 AIRPORT RD",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325412835",
            "telephone_number": "850-837-6645",
            "fax_number": "850-650-8553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL KELLUM, DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-07",
        "last_updated": "2014-07-07",
        "status": "A",
        "authorized_official_last_name": "KELLUM",
        "authorized_official_first_name": "HENRY",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-837-6645",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "FL",
            "license": "10931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Destin Dental Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Mary Jo Pace, CST, SA
• Brittany Palfi
• Chris George Pappas, MD
• Krasimir Ivanov Pashaliev
• Tessa Patterson
• Payne Chiropractic Life Center PA (Payne Chiropractic Wellness Center)
• Alan M Payne, DC
• Pediatric ABA 10 Inc
• Natalie Pelly, OD
• Jennifer Peterson, IMH

• Dental Clinic/Center in Destin, FL
• Providers in Destin, FL by specialty
• Dental Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2014; 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.