Keith Victor Nelson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5032263-9922 Issued in UT

Practice address

6183 S Prairie View Dr
Suite 101
Salt Lake City, UT 84129-3203

Phone

(801) 968-9147

Fax

(801) 966-2932

NPI assigned

Nov 30, 2006

Sex

Male

Sole proprietor

No

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

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

• Keith V Nelson DDS PC

  dba Signature Smiles Luxury Dental Spa

  • Dentist
  • Salt Lake City, UT
  • NPI 1316169162
  NPD (past) Authorized official

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366156800000",
    "number": "1275601395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6183 S PRAIRIE VIEW DR",
            "address_2": "SUITE 101",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841293203",
            "telephone_number": "801-968-9147",
            "fax_number": "801-966-2932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6183 S PRAIRIE VIEW DR",
            "address_2": "SUITE 101",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841293203",
            "telephone_number": "801-968-9147",
            "fax_number": "801-966-2932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "KEITH",
        "middle_name": "VICTOR",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2013-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "5032263-9922",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "62277",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Nelson, L.P.C.
• Jennifer Kalasky Nelson, PT, GCS
• Joshua Nelson
• Jostlen Nelson
• Kaylee Sarah Nelson, PA-C
• Kellie Nelson, M.D.
• Kevin Eric Nelson, M.D., PH.D.
• Kristine Louise Nelson, LCSW
• Kristopher A Nelson, OT
• Lisa Nelson, LCSW

• General Practice Dentistry in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2013; 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.