Destin Dental Care LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DESTIN DENTAL CARE LLC

Practice address

985 Airport Road
Destin, FL 32541-2835

Phone

(850) 837-6645

Fax

(850) 650-8553

NPI assigned

Mar 9, 2020

Organization subpart

No

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

Authorized official

Name

Henry Paul Kellum, D.D.S.NPI 1780753673

Title

Owner

Phone

(850) 837-6645

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.

• Henry Paul Kellum, D.D.S.

  • General Practice Dentistry
  • Destin, FL
  • NPI 1780753673
  NPD (past) Authorized official

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

{
    "created_epoch": "1583712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583712000000",
    "number": "1821623901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "985 AIRPORT ROAD",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325412835",
            "telephone_number": "850-837-6645",
            "fax_number": "850-650-8553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "985 AIRPORT ROAD",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325412835",
            "telephone_number": "850-837-6645",
            "fax_number": "850-650-8553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESTIN DENTAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-09",
        "last_updated": "2020-03-09",
        "certification_date": "2020-03-09",
        "status": "A",
        "authorized_official_last_name": "KELLUM",
        "authorized_official_first_name": "HENRY",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-837-6645",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Destin Cardiology LLC
• Destin Chiropractic Center
• Destin Chiropractic, PLLC
• Destin Counseling and Consulting LLC
• Destin Counseling and Consulting LLC
• Destin Dentistry, PLLC
• Destin Eye Care PA
• Destin Health Care Associates LLC
• Destin Housecalls, LLC
• Destin Ophthalmology, PA

• General Practice Dentistry in Destin, FL
• Providers in Destin, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2020; 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.