Active NPI
Gwendolyn A Kelly, D.D.S.
- General Practice Dentistry
- Inglewood, CA
National Provider Identifier
1316039324
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 29936
- Practice address
- 101 N la Brea Ave
Suite 506
Inglewood, CA 90301-1769 - Phone
- (310) 412-9291
- Fax
- (310) 412-1705
- NPI assigned
- Sep 28, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 29936 | CA | Primary |
Addresses
Primary practice location
101 N la Brea Ave
Suite 506
Inglewood, CA 90301-1769
Mailing address
101 N la Brea Ave
Suite 506
Inglewood, CA 90301-1769
Phone (310) 412-9291
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective May 3, 2016 through May 3, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29936 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lauren a. Mathews D.DS., Incorporated | Past | Accepting new patients | |
| Gwendolyn Kelly DDS & Assoc. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba Mathews Dental Group
- Dentist
- Westchester, CA
- NPI 1083271886
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1316039324",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 N LA BREA AVE",
"address_2": "SUITE 506",
"city": "INGLEWOOD",
"state": "CA",
"postal_code": "903011769",
"telephone_number": "310-412-9291",
"fax_number": "310-412-1705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 N LA BREA AVE",
"address_2": "SUITE 506",
"city": "INGLEWOOD",
"state": "CA",
"postal_code": "903011769",
"telephone_number": "310-412-9291",
"fax_number": "310-412-1705"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "GWENDOLYN",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "29936",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Inglewood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.