Kelly M. Gonzales, DDS, PC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

KELLY M. GONZALES, DDS, PC

Practice address

1103 Rivery Blvd
Ste 140
Georgetown, TX 78628-3034

Phone

(512) 864-9595

NPI assigned

Apr 14, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Kelly Marie Gonzales, DDSNPI 1417128687

Title

President

Phone

(512) 864-9595

Specialties & licenses 1

Addresses

Other names 1

• Star Smiles Pediatric Dentistry Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelly Marie Gonzales, DDS

  • Pediatric Dentistry
  • Georgetown, TX
  • NPI 1417128687
  NPD (past) Authorized official
• Alison Damarodas Campbell, DDS

  • Pediatric Dentistry
  • Georgetown, TX
  • NPI 1588788970
  NPD (past)

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

{
    "created_epoch": "1208131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253664000000",
    "number": "1801060660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 RIVERY BLVD",
            "address_2": "STE 140",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786283034",
            "telephone_number": "512-864-9595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 RIVERY BLVD",
            "address_2": "STE 140",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786283034",
            "telephone_number": "512-864-9595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY M. GONZALES, DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-14",
        "last_updated": "2009-09-23",
        "status": "A",
        "authorized_official_last_name": "GONZALES",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "512-864-9595",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Star Smiles Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Paul Alex Katigbak, M.D.
• Katrina Fairchild, PLLC
• Kearn Dialysis LLC
• Konnar Kechely, PT, DPT
• Jenna Kellogg, M.S., CCC-SLP
• Kelly M. McCabe, LPC-S, LMFT-S, PLLC
• Crystal Kelly, MD
• Mackenzie Kelly, DPT
• Margaret Dubois Kelly, M.S, CCC-SLP
• Kenny-Bao Thai Tran, MD, PA

• Pediatric Dentistry in Georgetown, TX
• Providers in Georgetown, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2009; 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.