Stephen Mathew Kelson, D.D.S., M.D.

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

DE61354113 Issued in WA

Practice address

3624 Ensign Rd NE Ste a
Olympia, WA 98506-5074

Phone

(360) 923-5412

NPI assigned

Feb 27, 2017

Last updated

Oct 3, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Nov 6, 2025 through Nov 6, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1488153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759449600000",
    "number": "1417497389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3624 ENSIGN RD NE STE A",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065074",
            "telephone_number": "360-923-5412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3624 ENSIGN RD NE STE A",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065074",
            "telephone_number": "360-923-5412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELSON",
        "first_name": "STEPHEN",
        "middle_name": "MATHEW",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-02-27",
        "last_updated": "2025-10-03",
        "certification_date": "2025-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "WA",
            "license": "DE61354113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael C Kelly, NP
• Tonya Michelle Kelly
• Theresa Ford Kelso, MSW
• Lauren Kelson, PA
• Michael R. Kelson, D.D.S.
• Ken P Lee MD PLLC
• Alta Blanche Kendall, ARNP NNP-BC
• Josefina Kender
• Jeffrey Lee Kendig, LPN
• Tracy Colleen Kenela, M.A., LMHC, CRC

• Oral & Maxillofacial Surgery (D.M.D.) in Olympia, WA
• Providers in Olympia, WA by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.