Derek R. Kaelin D.D.S, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

2003017125 Issued in MO

Legal business name

DEREK R. KAELIN D.D.S, LLC

Doing business as

James River Dental

Practice address

4205 S Nature Center Way
Springfield, MO 65804-4921

Phone

(417) 862-2468

NPI assigned

Jan 24, 2011

Last updated

Jan 24, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Derek R Kaelin, DDSNPI 1689710873

Title

Dentist Owner

Phone

(417) 862-2468

Specialties & licenses 1

Addresses

Other names 1

• James River Dental Doing business as

Tax ID family

Derek R Kaelin DDS LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Derek R. Kaelin, D.D.S, LLC

  dba Northside Dental Clinic

  • Dental Clinic/Center
  • Springfield, MO
  • NPI 1295030203
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Derek Ryan Kaelin, DDS

  • General Practice Dentistry
  • Springfield, MO
  • NPI 1689710873
  Authorized official Same address or phone

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

{
    "created_epoch": "1295827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295827200000",
    "number": "1285939157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 S NATURE CENTER WAY",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658044921",
            "telephone_number": "417-862-2468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4205 S NATURE CENTER WAY",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658044921",
            "telephone_number": "417-862-2468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEREK R. KAELIN D.D.S, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-24",
        "last_updated": "2011-01-24",
        "status": "A",
        "authorized_official_last_name": "KAELIN",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DENTIST OWNER",
        "authorized_official_telephone_number": "417-862-2468",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MO",
            "license": "2003017125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "James River Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dental 32, L.L.C. (Dental 32)
• Dental Solutions LLC (Smile Dental)
• Angelina Nicole-Marie Denton-Howell, FNP
• Brianna Denton, PHARMD
• Scarlet Kennedy Denton, CPM
• Derek R. Kaelin, D.D.S, LLC (Northside Dental Clinic)
• Karrie Derenski, PHARM.D.
• Justin Daniel Derges, DO
• Patricia Derges, MD
• Amanda Cowart Derham, LCSW

• Dental Clinic/Center in Springfield, MO
• Providers in Springfield, MO by specialty
• Dental Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2011; 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.