Sidney Dean Kelly, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

28463 Issued in CA

Practice address

2360 Professional Dr # 100
Roseville, CA 95661-7745

Phone

(916) 782-9479

Fax

(916) 782-3342

NPI assigned

Feb 26, 2007

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jacob D Kelly DDS, Inc.

  • Dental Clinic/Center
  • Roseville, CA
  • NPI 1447821319
  NPD (past)

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144356916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3470 BARKER RD",
            "city": "LOOMIS",
            "state": "CA",
            "postal_code": "956509034",
            "telephone_number": "916-660-0888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2360 PROFESSIONAL DR # 100",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956617745",
            "telephone_number": "916-782-9479",
            "fax_number": "916-782-3342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SIDNEY",
        "middle_name": "DEAN",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "28463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kori Kelley
• Jacob Dean Kelly, D.D.S.
• Judith Claire Kelly, LCSW, CSAT
• Julie L. Kelly, MD
• Randall Shawn Kelly, D.D.S.
• Sarah Kelso, RBT
• Nancy Kemp, MD
• Nancy L Kemp, OT
• John M. Kendra, PH.D.
• Kathleen M. Kennedy Hutton, RD

• General Practice Dentistry in Roseville, CA
• Providers in Roseville, CA by specialty
• General Practice Dentistry in California

• 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.

Verify at the official NPI Registry.