DR. JERRY C. KELLY (NPI# 1386853745) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386853745 |
| Entity Type | Individual |
| Full Name | DR. JERRY C. KELLY |
| Credential | DDS |
| Practice Address |
263 S Jefferson Ave Marshall MO 65340-2134 |
| Practice Telephone | 6608866843 |
| Practice Fax Number | 6608867855 |
| Mailing Telephone | 6608866843 |
| Mailing Fax Number | 6608867855 |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 12712 | MO | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | STATE LICENSE | 12712 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043611783 | Jerry Kelly | Military Health Care Provider | 1061 Harmon Ave, Fort Stewart, GA 31314-5641 | 2014-09-12 |
| 1881801397 | Jerry B Kelly | Pharmacist | 801 E 6th St, Panama City, FL 32401-3661 | 2007-05-16 |
| 1962559278 | Jerry S Kelly | Social Worker | 3719 Union Rd, Cheektowaga, NY 14225-4249 | 2007-01-05 |
| Street Address |
263 S JEFFERSON AVE |
| City | MARSHALL |
| State | MO |
| Zip Code | 65340-2134 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184195042 | Wright Dental LLC | Clinic/Center | 263 S Jefferson Ave, Marshall, MO 65340-2134 | 2018-12-17 |
| 1881186716 | Niki Denise Wright | Dentist | 263 S Jefferson Ave, Marshall, MO 65340-2134 | 2018-06-06 |
| 1962918425 | Marshall Dental Care, LLC | Clinic/Center | 263 S Jefferson Ave, Marshall, MO 65340-2134 | 2017-12-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336791847 | Gerald D Robertson | Chiropractor | 1566 S Odell Ave, Marshall, MO 65340 | 2019-07-15 |
| 1659860765 | William L Pearman | Nurse Practitioner | Marshall Emergency Physicians, 2305 South Highway 65, Marshall, MO 65340 | 2018-05-03 |
| 1992204978 | Susan Elizabeth Lichtenberg | Speech-Language Pathologist | 860 W. Vest St., Marshall, MO 65340 | 2018-02-06 |
| 1568974616 | Falin Kay Larsen | Family Medicine | 2303 Us-65, Marshal, MO 65340 | 2017-10-30 |
| 1881132587 | Dana Zinn | Nurse Practitioner | 1547 Commerce Dr, Marshall, MO 65340 | 2017-02-02 |
| 1760877179 | Lifetime Dental Associates | Dentist | 2301 S. 65 Hwy, Suite 1, Marshall, MO 65340 | 2015-04-02 |
| 1780078949 | Glenda Cervantes | Interpreter | 1324 S Ellswort Ave, Marshall, MO 65340 | 2015-03-26 |
| 1174922173 | Michelle Stockman | Licensed Practical Nurse | 1004 S. Lincoln Ave, Marshall, MO 65340 | 2014-08-15 |
| 1730527722 | Lynn C Evans | Pharmacist | 941 S. Cherokee, Suite 1, Marshall, MO 65340 | 2013-06-12 |
| 1740589753 | Bethany Anne Harris | Social Worker | 1126 E. Hwy Ww, Marshall, MO 65340 | 2011-03-17 |
| Find all providers in zip 65340 | ||||
| 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 |
|---|---|---|---|---|
| 1184241267 | Sarah Taipei | Dentist | 900 E End Blvd N Ste 200, Marshall, TX 75670-2166 | 2020-07-06 |
| 1508425075 | Erik Hill | Dentist | 1511 Carlson St, Marshall, MN 56258-2626 | 2019-06-10 |
| 1902359987 | Marshall Smiles Pllc | Dentist | 900 E End Blvd N, 200, Marshall, TX 75670 | 2016-07-26 |
| 1760877179 | Lifetime Dental Associates | Dentist | 2301 S. 65 Hwy, Suite 1, Marshall, MO 65340 | 2015-04-02 |
| 1073745725 | Michael R Thomas Dds | Dentist | 1511 Carlson St., Marshall, MN 56258-2626 | 2009-08-13 |
| 1386841179 | Darrell Mark Neel | Dentist | 402 W Bowie St, Marshall, TX 75670-4012 | 2007-06-27 |
| 1316149149 | Robert Walter Heidenreich | Dentist | 105 E Green Street, Marshall, MI 49068 | 2007-06-04 |
| 1639380561 | Paul Henry Domin | Dentist | 111 E Michigan Ave, Marshall, MI 49068-1543 | 2007-05-24 |
| 1497979090 | Craig M. Van Zyl | Dentist | 119 N Eagle St, Marshall, MI 49068-1501 | 2007-04-13 |
| 1255411096 | Douglas Alan Vandermeulen | Dentist | 207 Winston Dr, Marshall, MI 49068-8526 | 2006-10-16 |
| Find all providers in MARSHALL | ||||
Please comment or provide details below to improve the information on DR. JERRY C. KELLY.
| 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.