NPIMap

Organization Active NPI

Dr K'S Pediatric Dentistry

  • Dentist
  • Palmer, AK
National Provider Identifier
1922463850
Registry record updated Dec 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
1578 Issued in AK
Legal business name
DR K'S PEDIATRIC DENTISTRY
Practice address
125 W Evergreen Ave
#204
Palmer, AK 99645-6950
Phone
(209) 242-3439
NPI assigned
Dec 18, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2015

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

Authorized official

Name
Dr. Brian A Kelleher, DDS
Title
Owner
Phone
(209) 242-3439

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 1578 AK Primary

Addresses

Primary practice location

125 W Evergreen Ave
#204
Palmer, AK 99645-6950

Mailing address

1050 S Cobb St
Unit a
Palmer, AK 99645-6916
Phone (209) 602-0686

National Provider Directory

National Provider Directory
Tax ID family
Dr K'S Pediatric Dentistry2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1450396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450396800000",
    "number": "1922463850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 S COBB ST",
            "address_2": "UNIT A",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996456916",
            "telephone_number": "209-602-0686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 W EVERGREEN AVE",
            "address_2": "#204",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996456950",
            "telephone_number": "209-242-3439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR K'S PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-18",
        "last_updated": "2015-12-18",
        "status": "A",
        "authorized_official_last_name": "KELLEHER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "209-242-3439",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "AK",
            "license": "1578",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palmer, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 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.