Kellerman Dental

Primary specialty

DentistTaxonomy code 122300000X

License

1004560 Issued in IL

Legal business name

KELLERMAN DENTAL

Practice address

16 Junction Dr W Ste 101
Glen Carbon, IL 62034-2996

Phone

(618) 288-3535

NPI assigned

Apr 28, 2008

Last updated

Apr 28, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kevin J KellermanNPI 1962419317

Title

Doctor

Phone

(618) 288-3535

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kevin John Kellerman, D.M.D.

  • General Practice Dentistry
  • Glen Carbon, IL
  • NPI 1962419317
  NPD (past) Authorized official
• William J Hentze, DDS

  • Dentist
  • Glen Carbon, IL
  • NPI 1437324696
  NPD (past)
• Heather Danielle Taylor, DMD

  • Dentist
  • Collinsville, IL
  • NPI 1003291162
  NPD (past)

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

{
    "created_epoch": "1209340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209340800000",
    "number": "1215102579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 JUNCTION DR W STE 101",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620342996",
            "telephone_number": "618-288-3535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 JUNCTION DR W STE 101",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620342996",
            "telephone_number": "618-288-3535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLERMAN DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-28",
        "last_updated": "2008-04-28",
        "status": "A",
        "authorized_official_last_name": "KELLERMAN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "618-288-3535"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "1004560",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "108441",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Juilfs, NP
• Kaleidoscope Therapy, LLC
• Karvinen Counseling Services, PC
• Tracy Karvinen, MA, LPC, LCPC, CADC
• Linda Joan Kelleher, CNM
• Kellerman Dental Group, PC (Kellerman Cosmetic and Family Dentistry)
• Kevin John Kellerman, D.M.D.
• Seth Kelly, RPH
• Kyle Minor Kinder
• Angela Eleni Kioultzopoulos, M.S., CCC-SLP

• Dentist in Glen Carbon, IL
• Providers in Glen Carbon, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2008; 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.