Active NPI
Kelly Hendricks
- Pediatric Dentistry
- Santa Fe, NM
National Provider Identifier
1457773384
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DD4219
- Practice address
- 1439 S Saint Francis Dr
Santa Fe, NM 87505 - Phone
- (505) 473-5437
- NPI assigned
- Jan 13, 2014
- Last updated
- May 2, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | D10994 | OR | |
| Pediatric Dentistry | 1223P0221X | DD4219 | NM | Primary |
Addresses
Primary practice location
1439 S Saint Francis Dr
Santa Fe, NM 87505
Mailing address
1439 S Saint Francis Dr
Santa Fe, NM 87505-4037
Other practice location 1
1439 S Saint Francis Dr
Santa Fe, NM 87505
Phone (505) 473-5437
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 |
|---|---|---|---|
| DD4219 | NM | MD | Pediatric Dentist |
| D10994 | OR | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Whole Child Dental, LLC | Pediatric Dentistry | Past | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1389571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1556755200000",
"number": "1457773384",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1439 S SAINT FRANCIS DR",
"city": "SANTA FE",
"state": "NM",
"postal_code": "875054037"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1439 S SAINT FRANCIS DR",
"city": "SANTA FE",
"state": "NM",
"postal_code": "87505",
"telephone_number": "505-473-5437"
}
],
"practiceLocations": [
{
"address_1": "1439 S Saint Francis Dr",
"address_purpose": "LOCATION",
"city": "Santa Fe",
"state": "NM",
"postal_code": "87505",
"country_code": "US",
"telephone_number": "505-473-5437",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HENDRICKS",
"first_name": "KELLY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-01-13",
"last_updated": "2019-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "OR",
"license": "D10994",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NM",
"license": "DD4219",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Fe, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.