Dr. Stephen a. Kellam, LLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

1798 Issued in NM

Legal business name

DR. STEPHEN A. KELLAM, LLC

Practice address

539 Harkle Rd Ste D
Santa Fe, NM 87505-4783

Phone

(505) 982-5531

NPI assigned

Oct 31, 2011

Organization subpart

No

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

Authorized official

Name

Stephen A Kellam, D.M.D., M.S.NPI 1609916378

Title

President/Owner

Phone

(505) 982-5531

Specialties & licenses 1

Addresses

Other names 1

• Kellam Orthodontics Other name

Locations

Practitioners 1

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

• Stephen A Kellam, DMD, MS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Santa Fe, NM
  • NPI 1609916378
  NPD (past) Authorized official

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

{
    "created_epoch": "1320019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320019200000",
    "number": "1932485380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "539 HARKLE RD STE D",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875054783",
            "telephone_number": "505-982-5531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "539 HARKLE RD STE D",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875054783",
            "telephone_number": "505-982-5531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. STEPHEN A. KELLAM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-31",
        "last_updated": "2011-10-31",
        "status": "A",
        "authorized_official_last_name": "KELLAM",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "505-982-5531",
        "authorized_official_credential": "D.M.D., M.S."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NM",
            "license": "1798",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kellam Orthodontics",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in Santa Fe, NM
• Providers in Santa Fe, NM by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2011; 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.