NPIMap

Organization Active NPI

Derek R. Kaelin, D.D.S, LLC

  • Dental Clinic/Center
  • Springfield, MO
National Provider Identifier
1295030203
Registry record updated Jan 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
2003017125 Issued in MO
Legal business name
DEREK R. KAELIN, D.D.S, LLC
Practice address
2105 W Kearney St Ste a
Springfield, MO 65803-1666
Phone
(417) 862-2468
Fax
(417) 863-6775
NPI assigned
Jan 21, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2011

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

Authorized official

Name
Dr. Derek R Kaelin, DDS
Title
Dentist / Owner
Phone
(417) 862-2468

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 2003017125 MO Primary

Addresses

Primary practice location

2105 W Kearney St Ste a
Springfield, MO 65803-1666

Mailing address

2105 W Kearney St Ste a
Springfield, MO 65803-1666
Phone (417) 862-2468

Other names 1

  • Northside Dental Clinic Doing business as

National Provider Directory

National Provider Directory
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.

NPI Registry JSON

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

{
    "created_epoch": "1295568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295568000000",
    "number": "1295030203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 W KEARNEY ST STE A",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658031666",
            "telephone_number": "417-862-2468",
            "fax_number": "417-863-6775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 W KEARNEY ST STE A",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658031666",
            "telephone_number": "417-862-2468",
            "fax_number": "417-863-6775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEREK R. KAELIN, D.D.S, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-21",
        "last_updated": "2011-01-21",
        "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": "Northside Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springfield, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 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.