Active NPI
John Scott Keadle, DDS
- General Practice Dentistry
- Mooresville, NC
National Provider Identifier
1477605442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 5925
- Practice address
- 118 Gateway Blvd Ste a
Mooresville, NC 28117-6542 - Phone
- (704) 639-1330
- NPI assigned
- Jan 18, 2007
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5925 | NC | Primary |
Addresses
Primary practice location
118 Gateway Blvd Ste a
Mooresville, NC 28117-6542
Mailing address
18204 Mainsail Pointe Dr
Cornelius, NC 28031-5198
Phone (704) 650-0249
Other practice location 1
9320 Center Lake Dr Ste 100
Charlotte, NC 28216-0767
Phone (704) 509-4999
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 |
|---|---|---|---|
| 5925 | NC | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orthocare Oral Surgery | Past | Accepting new patients | |
| Orthodontic Care of Carolina, PA | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Oral and Maxillofacial Surgery (Dentist)
- Charlotte, NC
- NPI 1376121129
-
dba OrthoCare Orthodontics
- Orthodontics and Dentofacial Orthopedics Dentistry
- Charlotte, NC
- NPI 1740539782
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631664000000",
"number": "1477605442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18204 MAINSAIL POINTE DR",
"city": "CORNELIUS",
"state": "NC",
"postal_code": "280315198",
"telephone_number": "704-650-0249"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "118 GATEWAY BLVD STE A",
"city": "MOORESVILLE",
"state": "NC",
"postal_code": "281176542",
"telephone_number": "704-639-1330"
}
],
"practiceLocations": [
{
"address_1": "9320 Center Lake Dr Ste 100",
"address_purpose": "LOCATION",
"city": "Charlotte",
"state": "NC",
"postal_code": "282160767",
"country_code": "US",
"telephone_number": "704-509-4999",
"fax_number": "704-509-4961",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KEADLE",
"first_name": "JOHN",
"middle_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-18",
"last_updated": "2021-09-15",
"certification_date": "2021-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "5925",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mooresville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 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.