Kelly Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

2013017374 Issued in MO

Legal business name

KELLY DENTAL LLC

Practice address

1655 S. Enterprise Ave Ste. a-3
Springfield, MO 65804

Phone

(417) 881-1213

Fax

(417) 877-8156

NPI assigned

Oct 2, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Michael Chase Kelly, DDSNPI 1043659568

Title

Dentist

Phone

(417) 881-1213

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Chase Kelly, D.D.S.

  • General Practice Dentistry
  • Springfield, MO
  • NPI 1043659568
  NPD (past) Authorized official
• Elzie Irvin Miller III, DDS

  • General Practice Dentistry
  • Springfield, MO
  • NPI 1265429724
  NPD (past)

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

{
    "created_epoch": "1380672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380672000000",
    "number": "1922435148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1655 S ENTERPRISE AVE STE A3",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658041864",
            "telephone_number": "417-881-1213",
            "fax_number": "417-877-8156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1655 S. ENTERPRISE AVE STE. A-3",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "65804",
            "telephone_number": "417-881-1213",
            "fax_number": "417-877-8156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-02",
        "last_updated": "2013-10-02",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "CHASE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "417-881-1213",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MO",
            "license": "2013017374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley D Kelley, NP
• Kathryn L Kelley, MSW, LCSW
• Kelsi Kelley
• Deatrice Lumae Kellogg, MD
• Kalina Grace Kellogg
• Kevin J Kelly, PA-C
• Mandy A Kelly, MA, LPC
• Michael Chase Kelly, D.D.S.
• Vonita Kelly, LPC
• Lindsey Katharine Kelsay, RD, CSG, LD

• Dental Clinic/Center in Springfield, MO
• Providers in Springfield, MO by specialty
• Dental Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 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.