NPIMap

Organization Active NPI

Kerry Kelly D.D.S., P.C.

Doing business as Integrative Oral Health

  • Dentist
  • Ithaca, NY
National Provider Identifier
1700355849
Registry record updated Nov 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
KERRY KELLY D.D.S., P.C.
Doing business as
Integrative Oral Health
Practice address
1025 N. Tioga St.
Ithaca, NY 14850
Phone
(607) 272-4331
Fax
(607) 240-5618
NPI assigned
Nov 19, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2018

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

Authorized official

Name
Kerry Lyn Kelly, D.D.S., P.C
Title
Owner/Dentist
Phone
(607) 272-4331

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

1025 N. Tioga St.
Ithaca, NY 14850

Mailing address

1025 N. Tioga St.
Ithaca, NY 14850
Phone (607) 272-4331

Other identifiers 1

IdentifierTypeStateIssuer
02050572MedicaidNY

Other names 1

  • Integrative Oral Health Doing business as

National Provider Directory

National Provider Directory

Locations

1025 N Tioga St
Ithaca, NY 14850
Phone (607) 272-4331

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1542585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542585600000",
    "number": "1700355849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 N. TIOGA ST.",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "14850",
            "telephone_number": "607-272-4331",
            "fax_number": "607-240-5618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 N. TIOGA ST.",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "14850",
            "telephone_number": "607-272-4331",
            "fax_number": "607-240-5618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KERRY KELLY D.D.S., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-19",
        "last_updated": "2018-11-19",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "KERRY",
        "authorized_official_middle_name": "LYN",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "607-272-4331",
        "authorized_official_credential": "D.D.S., P.C"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02050572",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Integrative Oral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ithaca, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2018; 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.