Roah Kelly, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8066 Issued in OK

Practice address

2036 S Miller LN Ste B
Catoosa, OK 74015-1539

Phone

(918) 937-7660

NPI assigned

Apr 28, 2025

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1745798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745798400000",
    "number": "1033907423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16204 S 89TH EAST AVE",
            "city": "BIXBY",
            "state": "OK",
            "postal_code": "740084493",
            "telephone_number": "801-884-2460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2036 S MILLER LN STE B",
            "city": "CATOOSA",
            "state": "OK",
            "postal_code": "740151539",
            "telephone_number": "918-937-7660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "ROAH",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-04-28",
        "last_updated": "2025-04-28",
        "certification_date": "2025-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "8066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charlene D Hoover, ARNP
• Kerry Lea Hubbartt
• David K Johnson, PHARMD
• Lizbeth Johnson
• Richard Joe Jones
• Adam Christopher Kenney, DDS
• Jeanette King
• Emily Carol Kovin
• David Michael Krafft, PT
• Adam Lesher

• General Practice Dentistry in Catoosa, OK
• Providers in Catoosa, OK by specialty
• General Practice Dentistry in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2025; 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.