Kelley Ray Mingus, D.M.D

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D7191 Issued in OR

Practice address

225 Scalehouse Loop Ste 101
Bend, OR 97702-1241

Phone

(541) 382-6565

Fax

(541) 382-6776

NPI assigned

Jul 14, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2014 through Oct 1, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Smile Burns

  • Dental Clinic/Center
  • Burns, OR
  • NPI 1326858119

  General Practice

  NPD Authorized official

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

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736726400000",
    "number": "1447259262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 SCALEHOUSE LOOP STE 101",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021241",
            "telephone_number": "541-382-6565",
            "fax_number": "541-382-6776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 SCALEHOUSE LOOP STE 101",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977021241",
            "telephone_number": "541-382-6565",
            "fax_number": "541-382-6776"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "711 Ponderosa Vlg",
            "address_purpose": "LOCATION",
            "city": "Burns",
            "state": "OR",
            "postal_code": "977202315",
            "country_code": "US",
            "telephone_number": "541-589-4202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MINGUS",
        "first_name": "KELLEY",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-14",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D7191",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D7191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Bernard Mills, L.A.C
• Steven Gene Mills
• Richard A Millsap, CSFA
• Mind Health Consulting LLC
• Angelina Mingus, RN
• Sharyn Elaine Minnick
• Daniela Minnis, OD
• Daniel Mark Minter, PA
• Angela Marie Mion, OTR/L
• Maryam Mirahmadi

• General Practice Dentistry in Bend, OR
• Providers in Bend, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; 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.

Verify at the official NPI Registry.