Kelli L Ettelbrick, D.D.S., M.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

19146 Issued in TX

Practice address

8380 Warren Pkwy
Suite 400
Frisco, TX 75034-4198

Phone

(214) 387-0099

Fax

(214) 387-0104

NPI assigned

Jun 11, 2006

Last updated

Jul 27, 2009By the provider in NPPES

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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Frisco Dentistry for Kids

  • Pediatric Dentistry
  • Frisco, TX
  • NPI 1346597390
  NPD (past) Authorized official

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248652800000",
    "number": "1578505038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8380 WARREN PKWY",
            "address_2": "SUITE 400",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750344198",
            "telephone_number": "214-387-0099",
            "fax_number": "214-387-0104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8380 WARREN PKWY",
            "address_2": "SUITE 400",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750344198",
            "telephone_number": "214-387-0099",
            "fax_number": "214-387-0104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETTELBRICK",
        "first_name": "KELLI",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-11",
        "last_updated": "2009-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "19146",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "090844401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hannah Estrada, DC, MS
• Mayra Estrada, DDS
• Kimberly Estrella
• Kenneth Andrew Estrera, MD
• Parya Etebari, D.D.S.
• Jennifer Eubank
• Kiyah Herlong Eugene, CRNP
• Aaron Evans, P.T.
• Anna Evans, MSN, APRN, FNP-C
• Ashley Caroline Evans

• Pediatric Dentistry in Frisco, TX
• Providers in Frisco, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2009; 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.