Active NPI
Shelly L. McColm, D.D.S.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Lawrence, KS
National Provider Identifier
1073593992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- KS7061
- Practice address
- 12 W 8TH St
Lawrence, KS 66044-2602 - Phone
- (785) 832-0809
- NPI assigned
- Jan 18, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | KS7061 | KS | Primary |
Addresses
Primary practice location
12 W 8TH St
Lawrence, KS 66044-2602
Mailing address
5005 Inge CT
Lawrence, KS 66049-4835
Phone (785) 832-1782
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| KS7061 | Other | KS | 7061 |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| KS7061 | KS | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1073593992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5005 INGE CT",
"city": "LAWRENCE",
"state": "KS",
"postal_code": "660494835",
"telephone_number": "785-832-1782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 W 8TH ST",
"city": "LAWRENCE",
"state": "KS",
"postal_code": "660442602",
"telephone_number": "785-832-0809"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCOLM",
"first_name": "SHELLY",
"middle_name": "L.",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-01-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "KS",
"license": "KS7061",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "7061",
"identifier": "KS7061",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lawrence, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.