Elizabeth Kellner, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

D11686 Issued in OR

Practice address

2468 Tremont St
North Bend, OR 97459-3320

Phone

(541) 756-0156

NPI assigned

Feb 5, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Crocodile Smiles Children'S Dentistry, PLLC

  • Pediatric Dentistry
  • Oklahoma City, OK
  • NPI 1710165873
  NPD (past) Authorized official
• Stephen B. Rhodes, MD., Inc

  • Anesthesiology Physician
  • Oklahoma City, OK
  • NPI 1245228857

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667952000000",
    "number": "1760521934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7861",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731531861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2468 TREMONT ST",
            "city": "NORTH BEND",
            "state": "OR",
            "postal_code": "974593320",
            "telephone_number": "541-756-0156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLNER",
        "first_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-05",
        "last_updated": "2022-11-09",
        "certification_date": "2022-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OR",
            "license": "D11686",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OK",
            "license": "073",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200062680A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Trisha A Jordan, MA, CRC
• Kimberly Kanies
• Peter Alan Karth, MD
• Teneisha C Kay, RN
• Richard Keith
• Matthew Ewing Kelm
• Marly Kennedy, PMHNP
• Rene P Kidinger
• Dustin W King
• Stephen Jay Kinsley, M.D.

• Pediatric Dentistry in North Bend, OR
• Providers in North Bend, OR by specialty
• Pediatric Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2022; 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.