Kelly E. Carlen, DDS PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D3271 Issued in ID

Legal business name

KELLY E. CARLEN, DDS PLLC

Practice address

2811 12TH Ave Rd
Nampa, ID 83686-8482

Phone

(208) 461-1060

Fax

(208) 465-6303

NPI assigned

Apr 23, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Kelly Edward Carlen, DDS

Title

Owner

Phone

(208) 461-1060

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208908800000",
    "number": "1689849598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2811 12TH AVE RD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836868482",
            "telephone_number": "208-461-1060",
            "fax_number": "208-465-6303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2811 12TH AVE RD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836868482",
            "telephone_number": "208-461-1060",
            "fax_number": "208-465-6303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY E. CARLEN, DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-23",
        "last_updated": "2008-04-23",
        "status": "A",
        "authorized_official_last_name": "CARLEN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-461-1060",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ID",
            "license": "D3271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8061407",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelsie Beth Keller, RBT
• Kim Benson Keller, DDS
• Klint R Keller, DDS
• Tristen Isabella Keller, DPT
• Kelly B. Mansfield DDS PC
• Jessica Flores Kelly
• Makena Loryn Kelly, PA-C
• Charizma Kemp
• Susan Kemp, PHARMD
• Eric Paul Kendall, MD

• Dental Clinic/Center in Nampa, ID
• Providers in Nampa, ID by specialty
• Dental Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2008; 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.