Robert Louis Ketcham, D.D.S., M.S.D

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

12006504A Issued in IN

Practice address

1120 E Dupont Rd
Fort Wayne, IN 46825-1556

Phone

(260) 497-0497

Fax

(260) 489-4853

NPI assigned

Mar 26, 2007

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 1, 2014 through Oct 1, 2026

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.

• Orthodontic Specialty Services, Inc.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Fort Wayne, IN
  • NPI 1396858957
  NPD (past)

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211846400000",
    "number": "1841317518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 E DUPONT RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251556",
            "telephone_number": "260-497-0497",
            "fax_number": "260-489-4853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 E DUPONT RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251556",
            "telephone_number": "260-497-0497",
            "fax_number": "260-489-4853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETCHAM",
        "first_name": "ROBERT",
        "middle_name": "LOUIS",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-26",
        "last_updated": "2008-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "IN",
            "license": "12006504A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Lynn Kessens, LMHC
• Catherine Kessler
• Megan Kessler
• Sydnee Lee Kessler
• Julia Ketcham, SLP
• Christopher J Keto, M.D.
• Ashlee Keuneke, BCBA
• Natasha Rebecca Kever, C.O.T.A.
• Key Hearing AIDS of Fort Wayne South LLC
• Keys Chiropractic, P. C.

• Prosthodontics in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Prosthodontics in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2008; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.