Kelly Connaughton Mansour, D.M.D.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN18377 Issued in FL

Practice address

1650 N Maitland Ave
Maitland, FL 32751-3320

Phone

(407) 628-2286

Fax

(407) 629-2953

NPI assigned

Jul 6, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Kelly Lee Connaughton Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Pediatric Dentistry of Central Florida, LLP

  • Pediatric Dentistry
  • Maitland, FL
  • NPI 1770266926
  NPD

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

{
    "created_epoch": "1215302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696377600000",
    "number": "1558524041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 N MAITLAND AVE",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327513320",
            "telephone_number": "074-628-2286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 N MAITLAND AVE",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327513320",
            "telephone_number": "407-628-2286",
            "fax_number": "407-629-2953"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3109 Innovation Dr",
            "address_purpose": "LOCATION",
            "city": "Saint Cloud",
            "state": "FL",
            "postal_code": "347696501",
            "country_code": "US",
            "telephone_number": "407-593-8900",
            "fax_number": "407-556-3944",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANSOUR",
        "first_name": "KELLY",
        "middle_name": "CONNAUGHTON",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-06",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "DN18377",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN 18377",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "CONNAUGHTON",
            "middle_name": "LEE",
            "prefix": "DR.",
            "credential": "DMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Joseph Kunda Mambwe, MBA, CRPS, CBHT
• Rachel Mangan, M.A., CCC-SLP, ELL
• Sanjana Manghnani
• Erin E Manglardi, M.D.
• Lisa Marie Manning
• Eliana Rina Marc, LCSW
• Daniela Guadalupe Marcano, RMHCI
• Prudent Marcelin, MD
• Thamara Marcelin, NP
• Daniel J Marcone, LMHC

• Pediatric Dentistry in Maitland, FL
• Providers in Maitland, FL by specialty
• Pediatric Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.