Michael Chase Kelly, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2013017374 Issued in MO

Practice address

1655 S Enterprise Ave
A-3
Springfield, MO 65804-1850

Phone

(417) 881-1213

NPI assigned

Jun 18, 2013

Sex

Male

Sole proprietor

Yes

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

State licenses

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.

• Kelly Dental LLC

  • Dental Clinic/Center
  • Springfield, MO
  • NPI 1922435148
  NPD (past) Authorized official

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

{
    "created_epoch": "1371513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371513600000",
    "number": "1043659568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1655 S ENTERPRISE AVE",
            "address_2": "A-3",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658041850",
            "telephone_number": "417-881-1213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1655 S ENTERPRISE AVE",
            "address_2": "A-3",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658041850",
            "telephone_number": "417-881-1213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MICHAEL",
        "middle_name": "CHASE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-18",
        "last_updated": "2013-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2013017374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deatrice Lumae Kellogg, MD
• Kalina Grace Kellogg
• Kelly Dental LLC
• Kevin J Kelly, PA-C
• Mandy A Kelly, MA, LPC
• Vonita Kelly, LPC
• Lindsey Katharine Kelsay, RD, CSG, LD
• Alissa Keltner, M.S. CCC-SLP
• Grace Keltner
• Susan L Keltner

• General Practice Dentistry in Springfield, MO
• Providers in Springfield, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2013; 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.