Active NPI
Kelly Marie Kidwell, DMD
- General Practice Dentistry
- Tampa, FL
National Provider Identifier
1467945196
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 23360
- Practice address
- 9710 N Armenia Ave
Tampa, FL 33612-7507 - Phone
- (813) 930-8300
- NPI assigned
- Jun 7, 2018
- Sex
- Female
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 23360 | FL | Primary |
Addresses
Primary practice location
9710 N Armenia Ave
Tampa, FL 33612-7507
Mailing address
603 S Oregon Ave Apt E
Tampa, FL 33606-2577
Phone (727) 430-3738
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 |
|---|---|---|---|
| 23360 | FL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528329600000",
"number": "1467945196",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "603 S OREGON AVE APT E",
"city": "TAMPA",
"state": "FL",
"postal_code": "336062577",
"telephone_number": "727-430-3738"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9710 N ARMENIA AVE",
"city": "TAMPA",
"state": "FL",
"postal_code": "336127507",
"telephone_number": "813-930-8300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIDWELL",
"first_name": "KELLY",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-07",
"last_updated": "2018-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "23360",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.