Samantha Jo Kelly

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

10949 Issued in TN

Practice address

1710 Nashville Pike # 102
Gallatin, TN 37066

Phone

(615) 461-7491

NPI assigned

Jul 6, 2017

Last updated

Jul 25, 2019By the provider in NPPES

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Children's Dentistry of Gallatin

  • Pediatric Dentistry
  • Gallatin, TN
  • NPI 1467748921
  NPD

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

{
    "created_epoch": "1499299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564012800000",
    "number": "1255852661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1710 NASHVILLE PIKE",
            "city": "GALLATIN",
            "state": "TN",
            "postal_code": "370663154",
            "telephone_number": "615-461-7491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 NASHVILLE PIKE # 102",
            "city": "GALLATIN",
            "state": "TN",
            "postal_code": "37066",
            "telephone_number": "615-461-7491"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "705 Riley Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462025109",
            "country_code": "US",
            "telephone_number": "317-944-3865",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "705 Riley Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462025109",
            "country_code": "US",
            "telephone_number": "317-944-3865",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SAMANTHA",
        "middle_name": "JO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-06",
        "last_updated": "2019-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TN",
            "license": "10949",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IN",
            "license": "LDR170183",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason L Kastner, MD
• Meredith Rene Keeton, ATC, LAT
• Kayla Marie Kelley
• Lisa S Kellogg, D.O.
• Michael Sean Kellogg, DO
• Kellie Keown
• Savannah D Ketterer, PA-C
• Wardah Khan, NP
• Suzette Ann Denise Kilgore, M.D.
• Bora Kim, DMD

• Pediatric Dentistry in Gallatin, TN
• Providers in Gallatin, TN by specialty
• Pediatric Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2019; 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.