Goodloe Malone Keltner Jr., D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS3766 Issued in TN

Practice address

5866 Ridge Bend Rd
Suite 2
Memphis, TN 38120-9477

Phone

(901) 680-0364

Fax

(901) 680-0368

NPI assigned

Feb 5, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1760520241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5866 RIDGE BEND RD",
            "address_2": "SUITE 2",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381209477",
            "telephone_number": "901-680-0364",
            "fax_number": "901-680-0368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5866 RIDGE BEND RD",
            "address_2": "SUITE 2",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381209477",
            "telephone_number": "901-680-0364",
            "fax_number": "901-680-0368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELTNER",
        "first_name": "GOODLOE",
        "middle_name": "MALONE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "DS3766",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda Faye Kelly, FNP
• Sandra Lynn Kelly, DTR
• Willie Faye Kelly, NP
• Haley Kelso, BCBA
• Kacie Jay Kelso
• Kem'S House Inc.
• Ben B Kemker, D.C.
• Ashley Sharnelle Kemp
• Gregory Carroll Kemp, D.D.S.
• Jennifer Kemper, PHARM.D.

• General Practice Dentistry in Memphis, TN
• Providers in Memphis, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.