Active NPI
Kelley 'Corky' Deaton III, DMD
- General Practice Dentistry
- Danville, KY
National Provider Identifier
1851441802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 5843
- Practice address
- 359 S 4TH St
Suite C
Danville, KY 40422-2078 - Phone
- (859) 236-5703
- Fax
- (859) 936-1916
- NPI assigned
- Jan 11, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5843 | KY | Primary |
| Dentist | 122300000X | 5843 | KY |
Addresses
Primary practice location
359 S 4TH St
Suite C
Danville, KY 40422-2078
Mailing address
359 S 4TH St
Suite C
Danville, KY 40422-2078
Phone (859) 236-5703
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 45601382 | Other | KY | EPSDT DENTAL ID |
| 61-1180059 | Other | KY | TAX ID |
| 60058435 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5843 | KY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1426032000000",
"number": "1851441802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "359 S 4TH ST",
"address_2": "SUITE C",
"city": "DANVILLE",
"state": "KY",
"postal_code": "404222078",
"telephone_number": "859-236-5703",
"fax_number": "859-936-1916"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "359 S 4TH ST",
"address_2": "SUITE C",
"city": "DANVILLE",
"state": "KY",
"postal_code": "404222078",
"telephone_number": "859-236-5703",
"fax_number": "859-936-1916"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEATON",
"first_name": "KELLEY",
"middle_name": "'CORKY'",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-11",
"last_updated": "2015-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "KY",
"license": "5843",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "5843",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EPSDT DENTAL ID",
"identifier": "45601382",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "61-1180059",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "60058435",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Danville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.