DR. BENJAMIN KELLUM (NPI# 1225481930) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225481930 |
| Entity Type | Individual |
| Full Name | DR. BENJAMIN KELLUM |
| Credential | DDS |
| Practice Address |
Idaho State University Pocatello ID 83209-0001 |
| Practice Telephone | 2082823289 |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2016-07-18 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | D4772 | ID | Dental Providers |
| Street Address |
IDAHO STATE UNIVERSITY |
| City | POCATELLO |
| State | ID |
| Zip Code | 83209-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487689683 | Jennifer Holst | Audiologist | Idaho State University, 921 S. 8th Stop 8116, Pocatello, ID 83209-0001 | 2006-07-12 |
| 1023287612 | Steven Randall Lawyer | Psychologist | Idaho State University, Department of Psychology, Stop 8112, Pocatello, ID 83209-8112 | 2008-02-27 |
| 1881805109 | James E Creelman IIi | Physical Therapist | Idaho State University, Campus Box 8045, Pocatello, ID 83209-0001 | 2007-05-25 |
| 1922219161 | Loriann Helgeson | Occupational Therapist | Idaho State University, Campus Stop 8045, Pocatello, ID 83209-0001 | 2007-05-25 |
| 1609084136 | Alexander G Urfer | Physical Therapist | Idaho State University, Mail Stop 8045, Pocatello, ID 83209-0001 | 2007-05-18 |
| 1558434928 | Theodore William Peterson | Occupational Therapist | Idaho State University, Campus Box 8045, Pocatello, ID 83209-0001 | 2006-11-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093097081 | Eydie Kendall | Physical Therapist | 1400 Terry Drive, Pocatello, ID 83209 | 2011-09-15 |
| 1548548589 | Corrie Elizabeth Holmes | Audiologist | 650 Memorial Drive Building 68, Pocatello, ID 83209 | 2011-07-25 |
| 1730351081 | Idaho State University | Pharmacy | 990 South 8th, Pocatello, ID 83209 | 2008-03-27 |
| 1922204551 | Melody Ann Weaver | Nurse Practitioner | 921 S 8th Ave Stop 8101, Pocatello, ID 83209 | 2007-06-21 |
| 1710482500 | Ashley Letson | Specialist/Technologist | 921 S 8th Ave, Mcintosh Manor D9, Pocatello, ID 83209 | 2018-03-26 |
| 1407261407 | Stephen B Grandy | Dentist | 465 Memorial Drive, Pocatello, ID 83209-0000 | 2014-06-27 |
| 1811595929 | Idaho State University | Counselor | 1400 E Terry Dr Bldg 63, Pocatello, ID 83209-0001 | 2020-10-12 |
| 1174149389 | Santiago A Segura Barron | Specialist/Technologist | Holt Arena 550 Memorial Drive Building 50, Pocatello, ID 83209-0001 | 2020-06-23 |
| 1639658248 | Luis Rodriguez | Psychologist | 1400 Eas Terry Dr Bldg 63 Garrison Hall 5th Floor, Pocatello, ID 83209-0001 | 2018-08-14 |
| 1205384484 | Max Esposito | Physical Medicine & Rehabilitation | 1400 E Terry Dr, Pocatello, ID 83209-0001 | 2016-09-15 |
| Find all providers in zip 83209 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649619933 | Michael George | Dentist | 485 E Alameda Rd, Pocatello, ID 83201-3609 | 2013-06-19 |
| 1356643308 | Blackrock Dental Partners, Pllc | Dentist | 1606 E. Center St., Pocatello, ID 83201-4007 | 2010-11-24 |
| 1881810281 | Johnson & Snow Dental, Pa | Dentist | 1606 E Center St, Pocatello, ID 83201-4007 | 2007-04-17 |
| 1093876328 | William Jared Terry | Dentist | 2318 Douglas St, Pocatello, ID 83201-1851 | 2006-12-12 |
| 1386716041 | Lee R. Reddish | Dentist | 1980 Birdie Thompson Dr, Pocatello, ID 83201-2755 | 2006-11-15 |
| 1023194206 | Duane J Williams | Dentist | 1130 Call Creek Drive, Pocatello, ID 83201 | 2006-10-31 |
| 1477667335 | Gregory E Romriell | Dentist | 675 Yellowstone Ave Ste E, Pocatello, ID 83201-4511 | 2006-08-18 |
| 1154939619 | Julia Krek | Dentist | 921 S 8th Ave Stop 8088, Pocatello, ID 83209-0002 | 2020-07-21 |
| 1598382251 | Andrew Ringle | Dentist | 921 S 8th Ave Stop 8088, Pocatello, ID 83209-0002 | 2020-06-29 |
| 1093331076 | John Andrew Haslam | Dentist | 921 S 8th Ave Stop 8088, Pocatello, ID 83209-0002 | 2020-06-24 |
| Find all providers in POCATELLO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.