Jacob Dean Kelly, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

63699 Issued in CA

Practice address

2360 Professional Dr Ste 100
Roseville, CA 95661-7782

Phone

(916) 782-9479

Fax

(916) 782-9479

NPI assigned

Jul 23, 2014

Sex

Male

Sole proprietor

No

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

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.

• Jacob D Kelly DDS, Inc.

  • Dental Clinic/Center
  • Roseville, CA
  • NPI 1447821319
  NPD Authorized official
• James Robison, DMD, Inc

  • Dental Clinic/Center
  • Rocklin, CA
  • NPI 1649945155
  NPD (past)

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

{
    "created_epoch": "1406073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625097600000",
    "number": "1457769457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2360 PROFESSIONAL DR STE 100",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956617782",
            "telephone_number": "916-782-9479",
            "fax_number": "916-782-9479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2360 PROFESSIONAL DR STE 100",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956617782",
            "telephone_number": "916-782-9479",
            "fax_number": "916-782-9479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "JACOB",
        "middle_name": "DEAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-23",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "63699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelley Chiropractic
• Christopher Hori Kelley, D.C.
• Elana Kelley
• Gary C. Kelley, D.C.
• Kori Kelley
• Judith Claire Kelly, LCSW, CSAT
• Julie L. Kelly, MD
• Randall Shawn Kelly, D.D.S.
• Sidney Dean Kelly, DMD
• Sarah Kelso, RBT

• General Practice Dentistry in Roseville, CA
• Providers in Roseville, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.