Kelton Ericson DMD MD PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

KELTON ERICSON DMD MD PLLC

Practice address

8043 N 10TH St
Phoenix, AZ 85020-3770

Phone

(602) 758-9009

NPI assigned

May 4, 2024

Last updated

May 13, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kelton Ericson, DMD MDNPI 1972981025

Title

Owner/Doctor

Phone

(602) 758-9009

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kelton Ericson, D.M.D., M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Tucson, AZ
  • NPI 1972981025
  NPD Authorized official

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

{
    "created_epoch": "1714780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715558400000",
    "number": "1790532901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8043 N 10TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850203770",
            "telephone_number": "602-758-9009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8043 N 10TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850203770",
            "telephone_number": "602-758-9009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELTON ERICSON DMD MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-04",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-13",
        "status": "A",
        "authorized_official_last_name": "ERICSON",
        "authorized_official_first_name": "KELTON",
        "authorized_official_title_or_position": "OWNER/DOCTOR",
        "authorized_official_telephone_number": "602-758-9009",
        "authorized_official_credential": "DMD MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Virginia Kelsch, NNP
• Kayla Marie Kelsen, PMHNP-BC
• James Kelsey, LPTA
• Rachel Kelsey, MD
• Christina M Kelso, AU.D.
• John Patrick Kelty, L.C.S.W.
• Kelvin S Crezee DPM PC (Ahwatukee Ankle Foot and Leg Center)
• David Edward Kem, D.D.S.
• Laura Kemery, M.S. CCC-SLP
• Aaron W Kemp, MD

• Oral and Maxillofacial Surgery (Dentist) in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Oral and Maxillofacial Surgery (Dentist) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2024; 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.