NPIMap

Organization Active NPI

Diane C Kelly DMD, PC

Doing business as Childrens Dentistry at Hamilton Mill & Gainesville

  • Pediatric Dentistry
  • Gainesville, GA
National Provider Identifier
1740452465
Registry record updated Aug 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DNO12082 Issued in GA
Legal business name
DIANE C KELLY DMD, PC
Doing business as
Childrens Dentistry at Hamilton Mill & Gainesville
Practice address
655 Jesse Jewell Pkwy SE
Gainesville, GA 30501
Phone
(770) 539-9110
Fax
(678) 714-8388
NPI assigned
Apr 2, 2008
Last updated
Aug 19, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2008

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

Authorized official

Name
Diane C Kelly, DMDNPI 1851431522
Title
Owner - and Provider
Phone
(678) 714-7011

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X DNO12082 GA Primary

Addresses

Primary practice location

655 Jesse Jewell Pkwy SE
Gainesville, GA 30501

Mailing address

655 Jesse Jewell Pkwy SE
Gainesville, GA 30501
Phone (770) 539-9110

Other identifiers 10

IdentifierTypeStateIssuer
186794814AMedicaidGA
919057925BMedicaidGA
514725717BMedicaidGA
609963109EMedicaidGA
000851727BMedicaidGA
218323780AMedicaidGA
609963109LMedicaidGA
191450941AMedicaidGA
000046582YMedicaidGA
390489607JMedicaidGA

Other names 1

  • Childrens Dentistry at Hamilton Mill & Gainesville Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Children's Dentistry at Hamilton Mill2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1207094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219104000000",
    "number": "1740452465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 JESSE JEWELL PKWY SE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "30501",
            "telephone_number": "770-539-9110",
            "fax_number": "678-714-8388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 JESSE JEWELL PKWY SE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "30501",
            "telephone_number": "770-539-9110",
            "fax_number": "678-714-8388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIANE C KELLY DMD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-02",
        "last_updated": "2008-08-19",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER - AND PROVIDER",
        "authorized_official_telephone_number": "678-714-7011",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DNO12082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "186794814A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "919057925B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "514725717B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "609963109E",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000851727B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "218323780A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "609963109L",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "191450941A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000046582Y",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "390489607J",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Childrens Dentistry at Hamilton Mill & Gainesville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gainesville, GA

Sources for this page

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