Crystal Kelso, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D10498 Issued in OR

Practice address

62968 OB Riley Rd Ste 12
Bend, OR 97703-9443

Phone

(855) 433-6825

NPI assigned

Jul 15, 2016

Sex

Female

Sole proprietor

No

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 OR

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": "1468540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1790138642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6950 NE CAMPUS WAY",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971245611",
            "telephone_number": "503-952-2125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62968 OB RILEY RD STE 12",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977039443",
            "telephone_number": "855-433-6825"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1105 SE Jetty Ave",
            "address_2": "#B",
            "address_purpose": "LOCATION",
            "city": "Lincoln City",
            "state": "OR",
            "postal_code": "973672632",
            "country_code": "US",
            "telephone_number": "855-433-6825",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELSO",
        "first_name": "CRYSTAL",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-15",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D10498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jandi Kelly, MS, PHD
• Jennifer Marie Kelly, DPT
• Kara Lynn Kelly, N.P.
• Linda J Kelly, LCSW
• Lindsey Rhodes Kelly, RDN
• Kemple Memorial Children'S Dental Clinic
• Cheryl L Kemry, LMT
• Fredrick Frank Kennaday, RN
• Lisa Marie Kennedy-Leary, PT
• Kenya Marie Kennedy, LMT

• General Practice Dentistry in Bend, OR
• Providers in Bend, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2024; 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.