Active NPI
Joseph T. Kelly Sr., D.M.D.
- Dentist
- Clarks Summit, PA
National Provider Identifier
1972945509
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS017660L
- Practice address
- 103 W Grove St
Clarks Summit, PA 18411-2062 - Phone
- (570) 587-4787
- Fax
- (570) 586-2375
- NPI assigned
- Jul 24, 2013
- Last updated
- Jul 24, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS017660L | PA | Primary |
Addresses
Primary practice location
103 W Grove St
Clarks Summit, PA 18411-2062
Mailing address
103 W Grove St
Clarks Summit, PA 18411-2062
Phone (570) 587-4787
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 26, 2016 through Apr 26, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS017660L | PA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Joseph T. Kelly DMD PC | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1374624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374624000000",
"number": "1972945509",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "103 W GROVE ST",
"city": "CLARKS SUMMIT",
"state": "PA",
"postal_code": "184112062",
"telephone_number": "570-587-4787",
"fax_number": "570-586-2375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 W GROVE ST",
"city": "CLARKS SUMMIT",
"state": "PA",
"postal_code": "184112062",
"telephone_number": "570-587-4787",
"fax_number": "570-586-2375"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "JOSEPH",
"middle_name": "T.",
"name_prefix": "Dr.",
"name_suffix": "Sr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-07-24",
"last_updated": "2013-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS017660L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarks Summit, PA
- Kathleen Jo Karnoff, ABD
- Denise Marie Karpowicz, D.C.
- Kate Conklin, Registered Dietitian, LLC
- Julianne Kaub, PHARMD
- Joseph T. Kelly Jr., D.M.D.
- Keystone Community Resources Inc.
- Keystone Community Resources Inc.
- Keystone Community Resources, Inc.
- Keystone Community Resources, Inc.
- Keystone Independent Living Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.