Kelly Ross Carlisle, DMD, BS

Primary specialty

DentistTaxonomy code 122300000X

License

11287528-9922 Issued in UT

Practice address

535 E 500 S
Bountiful, UT 84010-3873

Phone

(801) 292-7807

NPI assigned

Jan 28, 2019

Last updated

Apr 9, 2020By the provider in NPPES

Sex

Male

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

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Science

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.

• Oral Design Dental

  • General Practice Dentistry
  • Holladay, UT
  • NPI 1477917458
  NPD (past)

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

{
    "created_epoch": "1548633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586390400000",
    "number": "1275097859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "391 W 3200 S",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "84010",
            "telephone_number": "408-621-7744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 E 500 S",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840103873",
            "telephone_number": "801-292-7807"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4802 S Holladay Blvd",
            "address_purpose": "LOCATION",
            "city": "Holladay",
            "state": "UT",
            "postal_code": "841175407",
            "country_code": "US",
            "telephone_number": "801-733-7035",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARLISLE",
        "first_name": "KELLY",
        "middle_name": "ROSS",
        "name_prefix": "Dr.",
        "credential": "DMD, BS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-01-28",
        "last_updated": "2020-04-09",
        "certification_date": "2020-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "11287528-9922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gina Markos Capps, CPNP
• Jennifer Rigby Cardinal, PHD, BCBA
• Kelci D Cardinal
• Shirlynn Rae Carey
• Ciara Carlisle
• Casey J Carolan, PTA
• Jason Carpenter
• Abigail Carter
• Jordan Scott Carver, PHARMD
• Ethan Cash

• Dentist in Bountiful, UT
• Providers in Bountiful, UT by specialty
• Dentist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2020; 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.