Kelsey Jo Fraser, DDS
Individual provider Active NPI General Practice Dentistry · Red Lodge, MT
NPI 1174052302 · NPPES record last updated Jun 26, 2019
Key facts
- NPI
- 1174052302
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 13445 (MT)
- Practice address
- 515 N Broadway Ave Ste 4
Red Lodge, MT 59068 - Phone
- (406) 662-0272
- NPI assigned
- Jun 10, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170822003937 | MT | Order and Referring Only - Other (Non-Physician) | 1557633799 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13445 | MT | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DEN-DEN-LIC-13445 | MT | |
| General Practice Dentistry | 1223G0001X | 13445 | MT | Yes |
Addresses
Primary practice location
515 N Broadway Ave Ste 4
Red Lodge, MT 59068
Mailing address
4448 Pine Cove Rd
Billings, MT 59106-1335
Phone (406) 853-1676
Other practice location 1
339 3rd St W
Hardin, MT 59034-1703
Phone (406) 629-3070
Other providers in Red Lodge, MT
- Craig C Erickson
- Shirley A Erickson
- Patrick Erley
- David George Evans
- Thomas Bradley Fouts
- Steven Wallace Fugere
- Richard D Gallagher
- William George
- Richard C Gessling
- Taryn A Hildebrandt
All providers in Red Lodge, MT · General Practice Dentistry in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 26, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.