Samuel Robert Kelly

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D10822 Issued in OR

Practice address

3380 Astoria Way NE
Salem, OR 97305-1667

Phone

(971) 600-0211

NPI assigned

Jun 23, 2018

Last updated

Jun 23, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

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.

• Samuel R Kelly DMD LLC

  • General Practice Dentistry
  • Salem, OR
  • NPI 1386441541
  NPD Authorized official

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

{
    "created_epoch": "1529712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529712000000",
    "number": "1174018022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3380 ASTORIA WAY NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973051667",
            "telephone_number": "971-600-0211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3380 ASTORIA WAY NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973051667",
            "telephone_number": "971-600-0211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SAMUEL",
        "middle_name": "ROBERT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-23",
        "last_updated": "2018-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D10822",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debra Kelly, RTR.
• Elizabeth Kelly, RN
• Michael Paul Kelly, PHARM.D.
• Robert B Kelly, M.D.
• Robert R Kelly, M.D.
• Tanner J Kelly, MD
• Victoria Kelly
• Michele J Kelsey, THW CRM PSS
• Patrick Joseph Kelty, BC-HIS
• Dorin Meredith Kemmerle, MD

• General Practice Dentistry in Salem, OR
• Providers in Salem, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2018; 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.