Individual provider Active NPI

Melissa Quellhorst, DDS

  • General Practice Dentistry
  • Pickerington, OH
National Provider Identifier
1790118966
Registry record updated Feb 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
30.024117 Issued in OH
Practice address
1555 Cross Creeks Blvd
Pickerington, OH 43147-8237
Phone
(614) 866-2895
Fax
(614) 866-2895
NPI assigned
Aug 12, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 30.024117 OH Primary

Addresses

Primary practice location

1555 Cross Creeks Blvd
Pickerington, OH 43147-8237

Mailing address

1555 Cross Creeks Blvd
Pickerington, OH 43147-8237
Phone (614) 866-2895

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20150609002058 OH Order and Referring Only - DentistPractitioner - Dentist 1951622422

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1376265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643846400000",
    "number": "1790118966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 CROSS CREEKS BLVD",
            "city": "PICKERINGTON",
            "state": "OH",
            "postal_code": "431478237",
            "telephone_number": "614-866-2895",
            "fax_number": "614-866-3533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 CROSS CREEKS BLVD",
            "city": "PICKERINGTON",
            "state": "OH",
            "postal_code": "431478237",
            "telephone_number": "614-866-2895",
            "fax_number": "614-866-2895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUELLHORST",
        "first_name": "MELISSA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-12",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30.024117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pickerington, OH

Sources for this page

Verify at the official NPI Registry.