Kelsey Coria Phillips, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

105480 Issued in CA

Practice address

120 C Ave Ste 100
Coronado, CA 92118-1992

Phone

(209) 518-9612

NPI assigned

Feb 9, 2019

Last updated

Jun 17, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• M Rashedi DMD Dental Corp

  • Pediatric Dentistry
  • San Marcos, CA
  • NPI 1699639922
  NPD (past)
• Marjan Rashedi DMD Inc

  dba SmileBuilders Childrens Dentistry

  • Pediatric Dentistry
  • San Marcos, CA
  • NPI 1740526771
  NPD (past)

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

{
    "created_epoch": "1549670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781654400000",
    "number": "1689139065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 C AVE STE 100",
            "city": "CORONADO",
            "state": "CA",
            "postal_code": "921181992",
            "telephone_number": "209-518-9612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 C AVE STE 100",
            "city": "CORONADO",
            "state": "CA",
            "postal_code": "921181992",
            "telephone_number": "209-518-9612"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "838 Nordahl Rd Ste 145",
            "address_purpose": "LOCATION",
            "city": "San Marcos",
            "state": "CA",
            "postal_code": "920693513",
            "country_code": "US",
            "telephone_number": "619-651-5470",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "222 Third Ave",
            "address_purpose": "LOCATION",
            "city": "Chula Vista",
            "state": "CA",
            "postal_code": "919102711",
            "country_code": "US",
            "telephone_number": "619-427-1315",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "KELSEY",
        "middle_name": "CORIA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-02-09",
        "last_updated": "2026-06-17",
        "certification_date": "2026-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "105480",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1659768802",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peter R. Kelly M.D. Inc (Peter R. Kelly M.D.)
• Deanna Sue Petersen, LCSW
• Laura Norton Petrovich, MD
• Michelle Pham, OD
• Alexander Phillips, DDS
• Dolores Anne Phin, D.C.
• Markay Picou-McKinney, MA
• Jaime Pitner
• Suzanne Margaret Popp, DDS
• Jorge Porras, M.D.

• Pediatric Dentistry in Coronado, CA
• Providers in Coronado, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2026; 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.