DR. SHANNON HOLER KELSO (NPI# 1407164502) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407164502 |
| Entity Type | Individual |
| Full Name | DR. SHANNON HOLER KELSO |
| Other Name | SHANNON FRANCES HOLER |
| Credential | DMD |
| Practice Address |
2156 Harden Blvd. Lakeland FL 33803 |
| Practice Telephone | 8636037400 |
| Practice Fax Number | 8636037411 |
| Mailing Telephone | 8636037400 |
| Mailing Fax Number | 8636037411 |
| Enumeration Date | 2010-09-23 |
| Last Update Date | 2019-03-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 122300000X | Dentist | 59793 | CA | Dental Providers |
| Y | 1223G0001X |
Dentist Specialization: General Practice |
DN20919 | FL | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346893914 | Shannon Kelso | Nurse Practitioner | 658 Kenilworth Dr Ste 206, Towson, MD 21204-2334 | 2019-07-22 |
| Street Address |
2156 HARDEN BLVD. |
| City | LAKELAND |
| State | FL |
| Zip Code | 33803 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861964819 | Steven P Agelidis | Counselor | 2020 S. Florida Ave, Suite 207, Lakeland, FL 33803 | 2018-12-31 |
| 1902316201 | Kesara Mai Ngam | Massage Therapist | 117 West Oak Drive, Lakeland, FL 33803 | 2017-10-02 |
| 1396260618 | Suncoast Behavioral Solutions, LLC | Behavioral Analyst | 1920 E Edgewood Dr Apt A8, Lakeland, FL 33803 | 2017-08-08 |
| 1316484413 | Daniel Jacob Stahl | Behavior Technician | 145 East Edgewood Drive, Lakeland, FL 33803 | 2017-01-26 |
| 1780037002 | Shelley Stettinius | Behavioral Analyst | 145 East Edgewood Dr, Lakeland, FL 33803 | 2016-07-21 |
| 1396106654 | Highlands Occupational Therapy, Inc | Occupational Therapist | 2000 East Edgewood Drive, Suite 114, Lakeland, FL 33803 | 2016-03-15 |
| 1003289570 | Jayna Dinsmore | Physical Therapy Assistant | 321 Imperial Blvd, D38, Lakeland, FL 33803 | 2015-11-05 |
| 1093187429 | Healthstat Wellness Polk-lakeland | Preventive Medicine | 3215 Winter Lake Road, Lakeland, FL 33803 | 2015-10-26 |
| 1962812545 | Florida Presbyterian Homes, Inc | Nursing Facility/Intermediate Care Facility | 901 Lakeside Avenue, Lakeland, FL 33803 | 2014-05-05 |
| 1710316336 | Trinity Endodontics | Health Maintenance Organization | 1602 S. Florida Ave, Ste #1, Lakeland, FL 33803 | 2013-11-04 |
| Find all providers in zip 33803 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366069817 | Benjamin H Ghaly | Dentist | 2926 S Florida Ave, Lakeland, FL 33803-4044 | 2020-07-01 |
| 1013534023 | Comfortable Care Dental Health Professionals, P.a. | Dentist | 7255 Kathleen Rd, Lakeland, FL 33810-4722 | 2020-06-26 |
| 1073006441 | Yasodhara Devi Vadlamudi | Dentist | 4849 Senander Cres, Lakeland, FL 33810-3726 | 2018-06-11 |
| 1467941609 | Comfortable Care Dental Health Professionals, P.a. | Dentist | 5170 Dave Robbins Way, Lakeland, FL 33812-4348 | 2018-05-03 |
| 1275062358 | Jean Paul Taveras | Dentist | 1251 Ariana St, Lakeland, FL 33803-1814 | 2017-06-12 |
| 1972916641 | Maryam Rostami | Dentist | 4204 Us Highway 98 N, Lakeland, FL 33809-3835 | 2014-06-10 |
| 1962814632 | Sean Wesley Coyle | Dentist | 3615 S Florida Ave Ste 850, Lakeland, FL 33803-4868 | 2014-05-28 |
| 1457791030 | Bruna Lounsberry | Dentist | 3756 Us Highway 98 N, Lakeland, FL 33809-3809 | 2013-06-27 |
| 1427300326 | Comfortable Care Dental Health Professionals | Dentist | 6440 Pearce Rd, Lakeland, FL 33809-4191 | 2012-10-03 |
| 1831441724 | Comfortable Care Dental Health Professionals | Dentist | 4335 Highland Park Blvd Ste 2, Lakeland, FL 33813-1627 | 2012-10-03 |
| Find all providers in LAKELAND | ||||
Please comment or provide details below to improve the information on DR. SHANNON HOLER KELSO.
| 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.