Kelly Carrothers Mantei, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN15067 Issued in FL

Practice address

2225 A1A S Ste A3
St Augustine, FL 32080-6374

Phone

(904) 471-7300

Fax

(904) 471-2708

NPI assigned

Aug 9, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Kelly Carrothers Mantei Other name

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 Feb 22, 2016 through Feb 22, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462752000000",
    "number": "1508876566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2225 A1A S STE A3",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320806374",
            "telephone_number": "904-471-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 A1A S STE A3",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320806374",
            "telephone_number": "904-471-7300",
            "fax_number": "904-471-2708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTEI",
        "first_name": "KELLY",
        "middle_name": "CARROTHERS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-09",
        "last_updated": "2016-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN15067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "MANTEI",
            "middle_name": "CARROTHERS",
            "prefix": "MRS.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Vivek M Manikal, MD
• Benjamin Manning
• Emily Manning, RBT
• Matthew Manning
• Manoj Prakash MD PA
• Marathon Health LLC
• Marathon Health LLC
• James Marchio, RD
• Robert Trent Marema, M.D., F.A.C.S.
• Whitney Marie Marema, RN

• General Practice Dentistry in St Augustine, FL
• Providers in St Augustine, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2016; 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.