Patrick J Kelly DDS , P.C

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901016290 Issued in MI

Legal business name

PATRICK J KELLY DDS , P.C

Practice address

4009 Fort St
Lincoln Park, MI 48146-4110

Phone

(313) 928-8555

Fax

(313) 928-1399

NPI assigned

Apr 3, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Shawn M Lavoie

Title

Insurance Biller

Phone

31392885555

Specialties & licenses 1

Addresses

Other names 1

• Fort Street Dentistry Doing business as

Medicare fee-for-service enrollment

Enrolled in MI2 enrollments

Enrollment records 2

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Patrick James Kelly, DDS

  • Dentist
  • Lincoln Park, MI
  • NPI 1629149372
  Medicare reassignment NPD
• Pauline Jiddou, D.D.S.

  • General Practice Dentistry
  • Lathrup Village, MI
  • NPI 1184812034
  Medicare reassignment
• Robert John Mora, DDS

  • Student in an Organized Health Care Education/Training Program
  • Lincoln Park, MI
  • NPI 1417704156

  General Practice

  NPD

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

{
    "created_epoch": "1333411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333411200000",
    "number": "1194081273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4009 FORT ST",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481464110",
            "telephone_number": "313-928-8555",
            "fax_number": "313-928-1399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4009 FORT ST",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481464110",
            "telephone_number": "313-928-8555",
            "fax_number": "313-928-1399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATRICK J KELLY DDS , P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-03",
        "last_updated": "2012-04-03",
        "status": "A",
        "authorized_official_last_name": "LAVOIE",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "INSURANCE BILLER",
        "authorized_official_telephone_number": "31392885555",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901016290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fort Street Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Misty Lynn Peete, LLC

• General Practice Dentistry in Lincoln Park, MI
• Providers in Lincoln Park, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.