John David Kisella, D.D.S., M.D

Primary specialty

SpecialistTaxonomy code 174400000X

Practice address

1208 Mann Dr
Suite 100
Matthews, NC 28105-7591

Phone

(704) 846-1166

Fax

(704) 849-2051

NPI assigned

Aug 1, 2006

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 19, 2019 through Dec 19, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• DRS Farrell, Farrell, Nale, Cook, Kapitan, Mohamed, Franco, Wessel, Ho

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Charlotte, NC
  • NPI 1972554186

  Oral and Maxillofacial Surgery

  NPD (past)
• DRS Farrell, Farrell, Nale, Cook, Kapitan, Mohamed, Franco, Wessel, Ho

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Rock Hill, SC
  • NPI 1861913022
  NPD (past)
• Indiana Spine Group, PC

  • Orthopaedic Surgery of the Spine Physician
  • Carmel, IN
  • NPI 1609960046
  NPD (past)
• Oral and Maxillofacial Surgery, P.C.

  • Oral and Maxillofacial Surgery (Dentist)
  • Marion, IN
  • NPI 1235248329
  NPD (past)

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1174530562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1208 MANN DR",
            "address_2": "SUITE 100",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281057591",
            "telephone_number": "704-846-1166",
            "fax_number": "704-849-2051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1208 MANN DR",
            "address_2": "SUITE 100",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281057591",
            "telephone_number": "704-846-1166",
            "fax_number": "704-849-2051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISELLA",
        "first_name": "JOHN",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NC",
            "license": "7871",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dekota King
• Kierra King
• Leah Brianne Kingswood, FNP
• Kelsey Laine Kinney, PT
• Megan Elise Kirkpatrick
• KJ Chiropractic Group PLLC,
• Justin Klein, DC
• Sharon Klein, HIS
• Tom J Kleitches
• Cherryl Lai Klitch, PA-C

• Specialist in Matthews, NC
• Providers in Matthews, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.