Active NPI
Kevin Erick Kelleher, D.M.D
- Orthodontics and Dentofacial Orthopedics Dentistry
- Midlothian, VA
National Provider Identifier
1265630404
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 0401411884
- Practice address
- 2412 Colony Crossing PL
Midlothian, VA 23112-4281 - Phone
- (804) 739-6673
- NPI assigned
- Jul 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 0401411884 | VA | Primary |
Addresses
Primary practice location
2412 Colony Crossing PL
Midlothian, VA 23112-4281
Mailing address
2412 Colony Crossing PL
Midlothian, VA 23112-4281
Phone (804) 739-6673
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401411884 | VA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355961600000",
"number": "1265630404",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2412 COLONY CROSSING PL",
"city": "MIDLOTHIAN",
"state": "VA",
"postal_code": "231124281",
"telephone_number": "804-739-6673"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2412 COLONY CROSSING PL",
"city": "MIDLOTHIAN",
"state": "VA",
"postal_code": "231124281",
"telephone_number": "804-739-6673"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEHER",
"first_name": "KEVIN",
"middle_name": "ERICK",
"credential": "D.M.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-07-10",
"last_updated": "2012-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "VA",
"license": "0401411884",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Midlothian, VA
- Keeton, Gokli, Lubbe, Bridges-Poquis & Raddin, (Pediatric Dentistry and Orthodontics of Virginia)
- James Pierce Kegley III, LAT, ATC
- Scott B Kegley, LPC
- Derek Kegyeda
- Hamilton Keith, PT
- Jennifer Pillard Keller, BCBA
- Kevin Achille Keller, MD
- Gordon Neil Kellett II, M.D.
- Alesha Nicol Kelley, COTA/L
- Ashley Redden Kelley, DPT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.