Sean Kelly, D.D.S.

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

License

0401007551 Issued in VA

Practice address

2209 E 32ND St
Tacoma, WA 98404-4922

Phone

(253) 593-0232

Fax

(253) 593-7216

NPI assigned

Dec 4, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1831257021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5615 70TH AVENUE CT W",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984674903",
            "telephone_number": "253-460-3384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2209 E 32ND ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984044922",
            "telephone_number": "253-593-0232",
            "fax_number": "253-593-7216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SEAN",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "VA",
            "license": "0401007551",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kendra Dane Kelly
• Khadine Kelly
• Michael John Kelly, M.D.
• Michael Joseph Kelly, M.D.
• Ryan Kelly, DO
• Stephen Kelly, PA-C
• Tawny Kelly
• Tracy T Kelly, MD
• William Samuel Kelly, MD
• Kemet Beauty, LLC

• Public Health Dentistry in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Public Health Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.