J. Kelly Theisen, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

DEN00106339 Issued in CO

Legal business name

J. KELLY THEISEN, D.D.S.

Practice address

521 E Railroad Avenue
Fort Morgan, CO 80701-3331

Phone

(970) 867-2256

Fax

(970) 542-9464

NPI assigned

Aug 6, 2015

Last updated

Aug 6, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. John Kelly Theisen, D.D.S.NPI 1629076989

Title

Owner

Phone

(970) 867-2256

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Kelly Theisen, D.D.S.

  • Dentist
  • Fort Morgan, CO
  • NPI 1629076989
  NPD (past) Authorized official

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

{
    "created_epoch": "1438819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438819200000",
    "number": "1871979393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 E RAILROAD AVENUE",
            "city": "FORT MORGAN",
            "state": "CO",
            "postal_code": "807013331",
            "telephone_number": "970-867-2256",
            "fax_number": "970-542-9464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 E RAILROAD AVENUE",
            "city": "FORT MORGAN",
            "state": "CO",
            "postal_code": "807013331",
            "telephone_number": "970-867-2256",
            "fax_number": "970-542-9464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J. KELLY THEISEN, D.D.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-06",
        "last_updated": "2015-08-06",
        "status": "A",
        "authorized_official_last_name": "THEISEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "KELLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "970-867-2256",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CO",
            "license": "DEN00106339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Shannonelaine Spalding John, MA

• Dentist in Fort Morgan, CO
• Providers in Fort Morgan, CO by specialty
• Dentist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 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.

Verify at the official NPI Registry.