Kelly Dove Dove, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2012015525 Issued in MO

Practice address

725 W Mt. Vernon St.
Nixa, MO 65714

Phone

(417) 708-9098

Fax

(417) 869-2469

NPI assigned

Jun 5, 2012

Sex

Female

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1338854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493942400000",
    "number": "1205197373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 W. MT. VERNON ST.",
            "city": "NIXA",
            "state": "MO",
            "postal_code": "65714",
            "telephone_number": "417-862-2468",
            "fax_number": "417-869-2469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 W MT. VERNON ST.",
            "city": "NIXA",
            "state": "MO",
            "postal_code": "65714",
            "telephone_number": "417-708-9098",
            "fax_number": "417-869-2469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOVE",
        "first_name": "KELLY",
        "middle_name": "DOVE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-05",
        "last_updated": "2017-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "201205525",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2012015525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dental Care of Nixa
• Raelin C Derevencha
• Door to Hope Counseling & Education
• Door to Hope Counseling & Education LLC
• Judith Ann Doran, LPC
• Madison Ryley Dowler
• Seth Dowler
• Brian James Duff, MD
• Morgan Lee Duffy
• Annette Duncan

• General Practice Dentistry in Nixa, MO
• Providers in Nixa, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2017; 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.