Patrick James Kelly, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2901016290 Issued in MI

Practice address

4009 Fort St
Lincoln Park, MI 48146-4110

Phone

(313) 928-8555

Fax

(313) 928-1399

NPI assigned

Nov 13, 2006

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

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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

• Patrick J Kelly DDS , P.C

  dba Fort Street Dentistry

  • General Practice Dentistry
  • Lincoln Park, MI
  • NPI 1194081273
  Medicare reassignment NPD

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490140800000",
    "number": "1629149372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4009 FORT ST",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481464110",
            "telephone_number": "313-928-8555",
            "fax_number": "313-928-1399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4009 FORT ST",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481464110",
            "telephone_number": "313-928-8555",
            "fax_number": "313-928-1399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "PATRICK",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2017-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901016290",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3334958",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephen Nicholas Kafkakis, LLBSW
• Frank Kardos III, DC
• Amy Elizabeth Karwowski, LLMSW
• Jafar Kassir
• Shahrdad Kazerani, D.M.D, M.S.
• Kimberly Dean Kemp
• Kennedy Dental Center of Michigan, P.C. (Kennedy Dental Center)
• Khalil and Usen DPM PC (Family Foot and Ankle Specialist)
• Khalil and Usen DPM PC II (Family Foot and Ankle II)
• Arif Ali Khan

• Dentist in Lincoln Park, MI
• Providers in Lincoln Park, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.