Active NPI
Peter J Kelly, DDS
- Dentist
- St Augustine, FL
National Provider Identifier
1649558412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN19430
- Practice address
- 2520 US Highway 1 S
St Augustine, FL 32086-6194 - Phone
- (904) 797-4833
- Fax
- (904) 797-7128
- NPI assigned
- Jul 28, 2011
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DN19430 | FL | Primary |
Addresses
Primary practice location
2520 US Highway 1 S
St Augustine, FL 32086-6194
Mailing address
865 Balch Ave
Winter Park, FL 32789-4917
Phone (407) 629-2161
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 |
|---|---|---|---|
| DN19430 | FL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Winter Park Dentistry | Past | Accepting new patients | |
| Comfortable Care Dental Health Professionals PA | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Dental Clinic/Center
- Winter Park, FL
- NPI 1588290837
-
dba St Augustine Family Dentistry
- General Practice Dentistry
- St Augustine, FL
- NPI 1619192614
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1311811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364515200000",
"number": "1649558412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "865 BALCH AVE",
"city": "WINTER PARK",
"state": "FL",
"postal_code": "327894917",
"telephone_number": "407-629-2161",
"fax_number": "407-629-2847"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2520 US HIGHWAY 1 S",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320866194",
"telephone_number": "904-797-4833",
"fax_number": "904-797-7128"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "PETER",
"middle_name": "J",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-07-28",
"last_updated": "2013-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN19430",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Augustine, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.