Active NPI
Kelli Sue Pershin, DDS
- General Practice Dentistry
- Pueblo, CO
National Provider Identifier
1619289121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 10215
- Practice address
- 3470 Parker Blvd
Pueblo, CO 81003-2280 - Phone
- (719) 543-4022
- Fax
- (719) 543-4008
- NPI assigned
- Jul 13, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 10215 | CO | Primary |
Addresses
Primary practice location
3470 Parker Blvd
Pueblo, CO 81003-2280
Mailing address
3470 Parker Blvd
Pueblo, CO 81003
Phone (719) 543-4022
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10215 | CO | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Park West Dental PC | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Pueblo, CO
- NPI 1033356670
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1278979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278979200000",
"number": "1619289121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3470 PARKER BLVD",
"city": "PUEBLO",
"state": "CO",
"postal_code": "81003",
"telephone_number": "719-543-4022",
"fax_number": "719-543-4008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3470 PARKER BLVD",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810032280",
"telephone_number": "719-543-4022",
"fax_number": "719-543-4008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERSHIN",
"first_name": "KELLI",
"middle_name": "SUE",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-07-13",
"last_updated": "2010-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CO",
"license": "10215",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.