Active NPI
Kelsey Lee Wittorf, DDS
- General Practice Dentistry
- Council Bluffs, IA
National Provider Identifier
1629636121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DDS-09644
- Practice address
- 1026 Woodbury Ave
Council Bluffs, IA 51503-7915 - Phone
- (712) 201-2289
- NPI assigned
- May 31, 2019
- 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 | DDS-09644 | IA | Primary |
Addresses
Primary practice location
1026 Woodbury Ave
Council Bluffs, IA 51503-7915
Mailing address
1026 Woodbury Ave
Council Bluffs, IA 51503-7915
Phone (712) 201-2289
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 |
|---|---|---|---|
| DDS-09644 | IA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559260800000",
"number": "1629636121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1026 WOODBURY AVE",
"city": "COUNCIL BLUFFS",
"state": "IA",
"postal_code": "515037915",
"telephone_number": "712-201-2289"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1026 WOODBURY AVE",
"city": "COUNCIL BLUFFS",
"state": "IA",
"postal_code": "515037915",
"telephone_number": "712-201-2289"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WITTORF",
"first_name": "KELSEY",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-31",
"last_updated": "2019-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IA",
"license": "DDS-09644",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Council Bluffs, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.