Michael R Kelson, DDS, PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

7100 Issued in WA

Legal business name

MICHAEL R KELSON, DDS, PLLC

Practice address

3624 Ensign Rd NE
Olympia, WA 98506-5074

Phone

(360) 923-5412

NPI assigned

May 9, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Michael Ross Kelson, D.D.S.

Title

Member

Phone

(360) 923-5412

Specialties & licenses 1

Addresses

Other names 1

• Olympia Oral & Maxillofacial Surgery Other name

Locations

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1699989749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3624 ENSIGN RD NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065074",
            "telephone_number": "360-923-5412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3624 ENSIGN RD NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065074",
            "telephone_number": "360-923-5412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL R KELSON, DDS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KELSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ROSS",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "360-923-5412",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "7100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Olympia Oral & Maxillofacial Surgery",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Oral and Maxillofacial Surgery (Dentist) in Olympia, WA
• Providers in Olympia, WA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.