Active NPI
Connor Fitzpatrick Kelley, DDS
- General Practice Dentistry
- Spring, TX
National Provider Identifier
1366724023
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 27404
- Practice address
- 1100 Rayford Rd
Ste. 100
Spring, TX 77386-1561 - Phone
- (281) 602-8843
- NPI assigned
- Sep 19, 2011
- Sex
- Male
- Sole proprietor
- No
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 | 27404 | TX | Primary |
Addresses
Primary practice location
1100 Rayford Rd
Ste. 100
Spring, TX 77386-1561
Mailing address
1100 Rayford Rd
Ste. 100
Spring, TX 77386-1561
Phone (281) 602-8843
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: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27404 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455494400000",
"number": "1366724023",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 RAYFORD RD",
"address_2": "STE. 100",
"city": "SPRING",
"state": "TX",
"postal_code": "773861561",
"telephone_number": "281-602-8843"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 RAYFORD RD",
"address_2": "STE. 100",
"city": "SPRING",
"state": "TX",
"postal_code": "773861561",
"telephone_number": "281-602-8843"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "CONNOR",
"middle_name": "FITZPATRICK",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-19",
"last_updated": "2016-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "27404",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spring, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2016; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.