DR. KELLY ANN DEZURA (NPI# 1306009881) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306009881 |
| Entity Type | Individual |
| Full Name | DR. KELLY ANN DEZURA |
| Credential | D.M.D. |
| Practice Address |
10181 Se Sunnyside Rd Otolaryngology (ent) Clackamas OR 97015 |
| Mailing Address |
3717 Ne 12th Ave Portland OR 97212-1241 |
| Practice Telephone | 5105714727 |
| Mailing Telephone | 4193066443 |
| Enumeration Date | 2008-07-06 |
| Last Update Date | 2013-08-28 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
D9858 | OR | Dental Providers |
| Street Address |
10181 SE SUNNYSIDE RD OTOLARYNGOLOGY (ENT) |
| City | CLACKAMAS |
| State | OR |
| Zip Code | 97015 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184103517 | Laurel Perilli | Physical Therapist | 12550 Se 93rd Ave Ste 265, Clackamas, OR 97015 | 2018-08-07 |
| 1306324538 | Kristin Connor Messing | Physical Therapist | 4805 Ne Glisan St, Prov Hall 7e06, Portland, OR 97015 | 2018-07-31 |
| 1902317266 | Darcy Jones Hamrick | Counselor | 12901 Se 97th Ave., Suite 340, Clackamas, OR 97015 | 2017-10-13 |
| 1841723384 | Manon Lavoie | Chiropractor | 17105 Se Sunnyside Rd, Suite 148, Happy Valley, OR 97015 | 2017-04-11 |
| 1235670126 | Michael G Short | Pedorthist | 10117 Se Sunnyside Rd., Ste. H, Clackamas, OR 97015 | 2017-03-13 |
| 1487100756 | Michael Joseph Peizner | Pharmacist | 16300se Evelyn Street, Clackamas, OR 97015 | 2016-08-28 |
| 1316395619 | Jennifer Elaine Walkowski | Physical Therapist | 9100 Se Sunnyside Road, Clackamas, OR 97015 | 2016-05-26 |
| 1649635384 | Brookside Dental - Milwaukie, LLC | Dentist | 9225 Se Sunnyside Rd. Ste 1, Clackamas, OR 97015 | 2015-12-23 |
| 1801216130 | Robert D. Grew Dmd, Inc. | Dentist | 10163 Se Sunnyside Road, Suite 414, Clackamas, OR 97015 | 2014-04-25 |
| 1508205410 | Valerie P Tabalno | Massage Therapist | 15661 Se 82nd Dr, Clackamas, OR 97015 | 2013-06-25 |
| Find all providers in zip 97015 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891874467 | John L Krump | Dentist | 9775 Se Sunnyside Rd, Suite 600, Clackamas, OR 97015-5739 | 2006-11-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831686468 | Jev A. Clark, Dmd, Md, LLC | Dentist | 120 Ramsgate Sq S Ste 110, Salem, OR 97302-5870 | 2018-04-19 |
| 1417385857 | Northwest Oral and Maxillofacial Surgeons | Dentist | 24850 Se Stark St Ste 100, Gresham, OR 97030-8317 | 2013-10-22 |
| 1457699142 | Bryan Christopher Williams | Dentist | 330 S Garden Way Ste 140, Eugene, OR 97401 | 2013-01-30 |
| 1689932063 | Garrett Welch | Dentist | 1475 Sw Chandler Ave Ste 101, Bend, OR 97702 | 2012-04-24 |
| 1164712022 | Travis Jon Hamilton | Dentist | 250 Church St Se Ste 102, Salem, OR 97301-3758 | 2011-04-12 |
| 1770887648 | Humble Richmond & Russell Oral & Maxillofacial Surgery, LLC | Dentist | 911 Main St Ste 180, Oregon City, OR 97045-1870 | 2011-01-06 |
| 1710291265 | Auzins Warrenton LLC | Dentist | 65 N Highway 101 Ste C, Warrenton, OR 97146-9313 | 2010-07-27 |
| 1932411303 | Normund Karl Auzins Dds | Dentist | 1725 Saint Helens St, Saint Helens, OR 97051-1744 | 2010-07-13 |
| 1356662845 | Baber Nazir Khatib | Dentist | 1849 Nw Kearney St Ste 300, Portland, OR 97209-1453 | 2010-06-18 |
| 1700012010 | Dylan S Spendal | Dentist | 5025 Ne Elam Young Pkwy, Suite 100, Hillsboro, OR 97124-6403 | 2009-06-02 |
| Find all providers with the same taxonomy | ||||
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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.