Individual provider Active NPI

Kerry W Nelson, DDS

  • General Practice Dentistry
  • San Antonio, TX
National Provider Identifier
1801818364
Registry record updated Jul 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
20528 Issued in TX
Practice address
9522 Potranco Rd
San Antonio, TX 78251-9601
Phone
(210) 675-9200
NPI assigned
Jul 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2020

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 20528 TX Primary

Addresses

Primary practice location

9522 Potranco Rd
San Antonio, TX 78251-9601

Mailing address

9522 Potranco Rd
San Antonio, TX 78251-9601
Phone (210) 675-9200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20190429000165 TX Order and Referring Only - DentistPractitioner - Dentist 9133461973

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
20528TXMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Westlakes Family Dental, PA General Practice CurrentSince Aug 2, 2020 Accepting new patients

Locations

9522 Potranco Rd
San Antonio, TX 78251
Phone (210) 569-0205

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595894400000",
    "number": "1801818364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9522 POTRANCO RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782519601",
            "telephone_number": "210-675-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9522 POTRANCO RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782519601",
            "telephone_number": "210-675-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "KERRY",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2020-07-28",
        "certification_date": "2020-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "20528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.