Corwin Jay Keltner, DDS, PPA

Primary specialty

DentistTaxonomy code 122300000X

License

323334-9922 Issued in UT

Practice address

5974 Fashion Point Dr Ste 210
Ogden, UT 84403-4842

Phone

(801) 475-6121

NPI assigned

Oct 26, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Modern Dental Professionals Ut, PC

  dba Monarch Dental - South Ogden

  • Dentist
  • South Ogden, UT
  • NPI 1265889166
  NPD
• Jay Keltner, D.D.D. P.a.

  dba Dental Associates

  • Dentist
  • Garden City, KS
  • NPI 1225292915
  NPD (past)
• Top Rocker Industries

  dba Scott Wilson DDS

  • General Practice Dentistry
  • Garden City, KS
  • NPI 1407164734
  NPD (past)

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670716800000",
    "number": "1083604599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 CANTERBURY LN",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843216714",
            "telephone_number": "435-773-2529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5974 FASHION POINT DR STE 210",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844034842",
            "telephone_number": "801-475-6121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1445 N 400 E Ste 34",
            "address_purpose": "LOCATION",
            "city": "Logan",
            "state": "UT",
            "postal_code": "843417564",
            "country_code": "US",
            "telephone_number": "435-752-1699",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELTNER",
        "first_name": "CORWIN",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "DDS, PPA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-26",
        "last_updated": "2022-12-11",
        "certification_date": "2022-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KS",
            "license": "60068",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "323334-9922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD ID",
            "identifier": "116645",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100392360B",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ryan M. Kelley, MD, PHD
• Alaina Kyle Kelly
• Easton Clint Kelsey, O.D.
• Kimball Kelsey
• Ross James Kelson, MD
• Danielle Ashly Kemmer
• Kristian Kemp, MD
• Kenneth H. Wadsworth, M.D., P.C.
• Kennington Hearing & Balance Center
• Kody D Kennington, AU.D.

• Dentist in Ogden, UT
• Providers in Ogden, UT by specialty
• Dentist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2022; 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.