Robert H Kelly, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

D9179 Issued in OR

Practice address

24540 E Welches Rd
Welches, OR 97067-0347

Phone

(503) 622-3085

NPI assigned

May 9, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

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

Practice roles

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.

• Robert H Kelly, DMD PC

  dba McKenzie Dental

  • Dentist
  • Welches, OR
  • NPI 1245669456
  NPD (past) Authorized official
• Brad a. McKenzie

  dba McKenzie Dental

  • Dentist
  • Welches, OR
  • NPI 1518280072
  NPD (past)

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383868800000",
    "number": "1811101876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24540 E WELCHES RD",
            "city": "WELCHES",
            "state": "OR",
            "postal_code": "970670347",
            "telephone_number": "503-622-3085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24540 E WELCHES RD",
            "city": "WELCHES",
            "state": "OR",
            "postal_code": "970670347",
            "telephone_number": "503-622-3085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "ROBERT",
        "middle_name": "H",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-09",
        "last_updated": "2013-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "HI",
            "license": "2114",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D9179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Frank George Cooper, M.S., L.P.C.
• Brianna Nicole Dittlinger, MSW, LCSW
• Darion Dunlap
• Ryan L Ellsworth, LCSW, CADC I
• Robin Fritsch, LMT
• Hilari Diana Kolstad
• Ericka Elise Lafever, LMT
• Julie Lazar, CHW
• Douglas Raymond Lyon, MD
• Brad Alexander McKenzie

• Dentist in Welches, OR
• Providers in Welches, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2013; 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.