Stephen S. Kelly, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

104240 Issued in CO

Practice address

2530 N 8TH St
Suite 103
Grand Junction, CO 81501-8857

Phone

(970) 245-2222

Fax

(970) 243-4438

NPI assigned

Sep 19, 2005

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

Other identifiers 1

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 5, 2012 through Dec 5, 2026

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Radiology Associates

  • Specialist
  • Pueblo, CO
  • NPI 1043206311
  NPD (past)

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

{
    "created_epoch": "1127088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212451200000",
    "number": "1528053204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2530 N 8TH ST",
            "address_2": "SUITE 103",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815018857",
            "telephone_number": "970-245-2222",
            "fax_number": "970-243-4438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 N 8TH ST",
            "address_2": "SUITE 103",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815018857",
            "telephone_number": "970-245-2222",
            "fax_number": "970-243-4438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "STEPHEN",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-19",
        "last_updated": "2008-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CO",
            "license": "104240",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04014940",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lacinda M Kelleher, RN
• Kevin E Keller, MD
• Richard Keller, M.D.
• William A Kelley, M.D.
• Isaac Scott Kelly, PA-C
• Stephanie Kelty
• Sheri Kembel, FNP-C
• Leisel Maria Kemp, B.A.
• Glenn Ross Kempeers, MD
• Barbara L Kennedy, LCSW

• Oral and Maxillofacial Surgery (Dentist) in Grand Junction, CO
• Providers in Grand Junction, CO by specialty
• Oral and Maxillofacial Surgery (Dentist) in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2008; 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.