Active NPI
Joseph Patrick Kelly, DDS
- Pediatric Dentistry
- Crofton, NE
National Provider Identifier
1083756860
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 5907
- Practice address
- 89574 545 Ave
Crofton, NE 68730-3238 - Phone
- (206) 948-2763
- NPI assigned
- Feb 12, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 5907 | NE | Primary |
Addresses
Primary practice location
89574 545 Ave
Crofton, NE 68730-3238
Mailing address
89574 545 Ave
Crofton, NE 68730-3238
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 |
|---|---|---|---|
| 5907 | NE | MD | Pediatric Dentist |
Interoperability endpoints
- jkelly3994@direct.seattlechildrens.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083756860",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "89574 545 AVE",
"city": "CROFTON",
"state": "NE",
"postal_code": "687303238"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "89574 545 AVE",
"city": "CROFTON",
"state": "NE",
"postal_code": "687303238",
"telephone_number": "206-948-2763"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "JOSEPH",
"middle_name": "PATRICK",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NE",
"license": "5907",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crofton, NE
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.