NPIMap

Organization Active NPI

Kellogg & Kellogg PS

  • Dentist
  • Walla Walla, WA
National Provider Identifier
1912124637
Registry record updated May 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE00004225 Issued in WA
Legal business name
KELLOGG & KELLOGG PS
Practice address
1602 Penny LN
Walla Walla, WA 99362-4477
Phone
(509) 522-0940
Fax
(509) 525-9063
NPI assigned
Apr 20, 2007
Last updated
May 31, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2013

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

Authorized official

Name
Dr. Don R Kellogg, DDSNPI 1700093127
Title
Secretary
Phone
(509) 522-0940

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DE00004225 WA Primary

Addresses

Primary practice location

1602 Penny LN
Walla Walla, WA 99362-4477

Mailing address

1602 Penny LN
Walla Walla, WA 99362-4477
Phone (509) 522-0940

Other identifiers 1

IdentifierTypeStateIssuer
5023346MedicaidWA

Other names 1

  • Tietan Dental Team Other name

National Provider Directory

National Provider Directory

Locations

1602 Penny Ln
Walla Walla, WA 99362
Phone (509) 522-0940

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369958400000",
    "number": "1912124637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1602 PENNY LN",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993624477",
            "telephone_number": "509-522-0940",
            "fax_number": "509-525-9063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1602 PENNY LN",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993624477",
            "telephone_number": "509-522-0940",
            "fax_number": "509-525-9063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLOGG & KELLOGG PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2013-05-31",
        "status": "A",
        "authorized_official_last_name": "KELLOGG",
        "authorized_official_first_name": "DON",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "509-522-0940",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00004225",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5023346",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tietan Dental Team",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Walla Walla, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2013; 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.