Henry Paul Kellum, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10931 Issued in FL

Practice address

985 Airport Rd
Destin, FL 32541-2835

Phone

(850) 837-6645

NPI assigned

Nov 7, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Destin Dental Care LLC

  • General Practice Dentistry
  • Destin, FL
  • NPI 1821623901
  NPD (past) Authorized official
• Paul Kellum, DDS

  • Dental Clinic/Center
  • Destin, FL
  • NPI 1033525431
  NPD (past) Authorized official

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780753673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "985 AIRPORT RD",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325412835",
            "telephone_number": "850-837-6645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "985 AIRPORT RD",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325412835",
            "telephone_number": "850-837-6645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLUM",
        "first_name": "HENRY",
        "middle_name": "PAUL",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "10931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia M Nickle LMHC, Inc
• Shaun Kahn, DC
• Michael Kalustian II, D.C
• Kathleen Cazenavette
• Shayna Keen, OTD, OTR/L, CNS
• Kimberly Yon-Davis, LCSW, PLLC
• Maci Kirkland
• Shannon Knapp, NCLEC, ABOC, LDO
• Thomas F Kracht Jr., DC
• Donald Krah Jr., COTA

• General Practice Dentistry in Destin, FL
• Providers in Destin, FL by specialty
• General Practice Dentistry in Florida

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.