Organization Active NPI

Family Dentistry

  • General Practice Dentistry
  • Albany, NY
National Provider Identifier
1053582908
Registry record updated Jul 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
026473-1 Issued in NY
Legal business name
FAMILY DENTISTRY
Practice address
489 Western Ave
Albany, NY 12203
Phone
(518) 438-8161
Fax
(518) 438-8123
NPI assigned
Mar 19, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2008

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

Authorized official

Name
Dr. Kenneth Kelman, DDS
Title
Owner
Phone
(518) 438-8161

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 026473-1 NY Primary

Addresses

Primary practice location

489 Western Ave
Albany, NY 12203

Mailing address

489 Western Ave
Albany, NY 12203
Phone (518) 438-8161

Other identifiers 1

IdentifierTypeStateIssuer
00393031MedicaidNY

National Provider Directory

National Provider Directory

Locations

489 Western Ave
Albany, NY 12203
Phone (518) 438-8161

NPI Registry JSON

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

{
    "created_epoch": "1205884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216252800000",
    "number": "1053582908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "489 WESTERN AVE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "12203",
            "telephone_number": "518-438-8161",
            "fax_number": "518-438-8173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "489 WESTERN AVE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "12203",
            "telephone_number": "518-438-8161",
            "fax_number": "518-438-8123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-19",
        "last_updated": "2008-07-17",
        "status": "A",
        "authorized_official_last_name": "KELMAN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "518-438-8161",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "026473-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00393031",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2008; 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.