Kellie Kendrick Cleveland, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

21699 Issued in TX

Practice address

4110 FM 407 Ste 150
Flower Mound, TX 75077

Phone

(940) 455-7004

Fax

(940) 455-7064

NPI assigned

Feb 28, 2007

Last updated

Jun 4, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

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 Feb 1, 2016 through Feb 1, 2028

Medicare enrollment (NPD)

Not enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lantana Family Dentistry, PA

  • General Practice Dentistry
  • Lewisville, TX
  • NPI 1326315136
  NPD (past) Authorized official

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559606400000",
    "number": "1265569909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4110 FM 407 STE 150",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750777216",
            "telephone_number": "940-455-7004",
            "fax_number": "940-455-7064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4110 FM 407 STE 150",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "75077",
            "telephone_number": "940-455-7004",
            "fax_number": "940-455-7064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEVELAND",
        "first_name": "KELLIE",
        "middle_name": "KENDRICK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-28",
        "last_updated": "2019-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "21699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christi Lynn Clay
• Clear Vision Associates PLLC (Clear Eye Care)
• Clearsky Rehabilitation Hospital of Flower Mound LLC
• Sara Cleland
• Jennifer Clements-Down, LMT
• Gordon Niel Climer, LCSW
• Nicole Cocker, OTR
• Kristen M Coffman, PT
• Denise Cole, MSN, RN, PNP
• Bradley Scott Colton, M.D.

• General Practice Dentistry in Flower Mound, TX
• Providers in Flower Mound, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2019; 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.