NPIMap

Organization Active NPI

Timothy M. Kelly, DMD, PA

  • Public Health Dentistry
  • Albuquerque, NM
National Provider Identifier
1558736991
Registry record updated Feb 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health DentistryTaxonomy code 1223D0001X
License
1413 Issued in NM
Legal business name
TIMOTHY M. KELLY, DMD, PA
Practice address
1441 Carlisle Blvd NE
Suite D
Albuquerque, NM 87110-5610
Phone
(505) 256-1770
Fax
(505) 255-0220
NPI assigned
Dec 10, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2021

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

Authorized official

Name
Dr. Timothy M Kelly, DMD, PANPI 1659427318
Title
Owner/Dentist
Phone
(505) 256-1770

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223D0001X 1413 NM Primary
Durable Medical Equipment & Medical Supplies 332B00000X
Customized Equipment (DME) 332BC3200X 1413 NM

Addresses

Primary practice location

1441 Carlisle Blvd NE
Suite D
Albuquerque, NM 87110-5610

Mailing address

1441 Carlisle Blvd NE
Suite D
Albuquerque, NM 87110-5610
Phone (505) 256-1770

National Provider Directory

National Provider Directory

Locations

1441 Carlisle Blvd NE
Ste D
Albuquerque, NM 87110
Phone (505) 256-1770

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1449705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613692800000",
    "number": "1558736991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 CARLISLE BLVD NE",
            "address_2": "SUITE D",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871105610",
            "telephone_number": "505-256-1770",
            "fax_number": "505-255-0220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 CARLISLE BLVD NE",
            "address_2": "SUITE D",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871105610",
            "telephone_number": "505-256-1770",
            "fax_number": "505-255-0220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMOTHY M. KELLY, DMD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-10",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "505-256-1770",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, PA"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Dental Public Health",
            "state": "NM",
            "license": "1413",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NM",
            "license": "1413",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 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.

Verify at the official NPI Registry.