Active NPI
Peter Benjamin McClellan, DDS
- Dentist
- Honolulu, HI
National Provider Identifier
1427364025
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DT-2489
- Practice address
- 2104 S King St
Honolulu, HI 96826-2232 - Phone
- (808) 949-6608
- Fax
- (808) 946-4555
- NPI assigned
- Aug 20, 2010
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DT-2489 | HI | Primary |
Addresses
Primary practice location
2104 S King St
Honolulu, HI 96826-2232
Mailing address
2104 S King St
Honolulu, HI 96826-2232
Phone (808) 949-6608
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT-2489 | HI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Red Bridge Family Dental | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Dental Clinic/Center
- Kansas City, MO
- NPI 1619583895
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357084800000",
"number": "1427364025",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2104 S KING ST",
"city": "HONOLULU",
"state": "HI",
"postal_code": "968262232",
"telephone_number": "808-949-6608",
"fax_number": "808-946-4555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2104 S KING ST",
"city": "HONOLULU",
"state": "HI",
"postal_code": "968262232",
"telephone_number": "808-949-6608",
"fax_number": "808-946-4555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCLELLAN",
"first_name": "PETER",
"middle_name": "BENJAMIN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-08-20",
"last_updated": "2013-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "HI",
"license": "DT-2489",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Honolulu, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.