DR. MICHAEL R. KELSON (NPI# 1356681407) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356681407 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL R. KELSON |
| Credential | D.D.S. |
| Practice Address |
3624 Ensign Rd Ne Suite A Olympia WA 98506-5074 |
| Practice Telephone | 3609235412 |
| Practice Fax Number | 3609235382 |
| Mailing Telephone | 3609235412 |
| Mailing Fax Number | 3609235382 |
| Enumeration Date | 2013-02-27 |
| Last Update Date | 2013-02-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
7100 | WA | Dental Providers |
| Street Address |
3624 ENSIGN RD NE SUITE A |
| City | OLYMPIA |
| State | WA |
| Zip Code | 98506-5074 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528020872 | William Beppu | Anesthesiology | 3624 Ensign Rd Ne, Ste B, Olympia, WA 98506-5074 | 2006-04-03 |
| 1205150687 | Sara Michelle Ellsworth | Counselor | 3624 Ensign Rd Ne, Suite 5, Olympia, WA 98506-5074 | 2010-03-15 |
| 1558514349 | Zachary H. Chen, Md, Pllc | Clinic/Center | 3624 Ensign Rd Ne, Suite E, Olympia, WA 98506-5074 | 2008-10-24 |
| 1699989749 | Michael R Kelson, Dds, Pllc | Dentist | 3624 Ensign Rd Ne, Olympia, WA 98506-5074 | 2007-05-09 |
| 1710015136 | Melissa G. Kohler | Acupuncturist | 3624 Ensign Rd Ne, Suite B, Olympia, WA 98506-5074 | 2007-02-28 |
| 1679689780 | Zachary H Chen | Internal Medicine | 3624 Ensign Rd Ne, Suite E, Olympia, WA 98506-5074 | 2006-08-22 |
| 1609819044 | John Mark Wagner | Anesthesiology | 3624 Ensign Rd Ne, Ste B, Olympia, WA 98506-5074 | 2006-06-14 |
| 1588607972 | Robert Wharton | Anesthesiology | 3624 Ensign Rd Ne, Ste B, Olympia, WA 98506-5074 | 2006-06-14 |
| 1073555058 | Bryan D Wales | Anesthesiology | 3624 Ensign Rd Ne, Ste B, Olympia, WA 98506-5074 | 2006-06-12 |
| 1801836440 | Gilbert Vorhoff Jr. | Anesthesiology | 3624 Ensign Rd Ne, Ste B, Olympia, WA 98506-5074 | 2006-06-08 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477185460 | Chloe Harper | Technician, Other | 3443 Lilly Rd Se, Ste B, Olympia, WA 98506 | 2020-02-07 |
| 1912543539 | Jessica Marie Radakovich | Licensed Practical Nurse | 3426 Mary Elder Rd, Olympia, WA 98506 | 2019-11-19 |
| 1669014973 | Arlene Josephine Adams | Registered Nurse | 413 Lily Rd Ne, Olympia, WA 98506 | 2019-10-09 |
| 1861999120 | Debra Delores Barker | Licensed Practical Nurse | 3710 South Bay Rd Ne, Olympia, WA 98506 | 2018-04-12 |
| 1801304431 | Michelle Warner | Nurse Practitioner | 205 Lilly Rd Ne Ste A1, Olympia, WA 98506 | 2018-01-17 |
| 1396258364 | Institute for Family Development | Community/Behavioral Health | 204 Quince St. Ne, Suite 200, Olympia, WA 98506 | 2017-11-13 |
| 1083137715 | Cameron Kunkel | Specialist/Technologist | 2512 20th Ave Ne, Olympia, WA 98506 | 2017-07-25 |
| 1184144768 | Trevor Shane Kwan | Family Medicine | 525 Lilly Road Ne, Olympia, WA 98506 | 2017-06-23 |
| 1073043212 | Michael H Harburg | Behavior Technician | 3857 Martin Way Ne, Olympia, WA 98506 | 2017-06-19 |
| 1780114371 | Priscilla Kangyang Jadu | Counselor | 3857 Martin Way E., Olympia, WA 98506 | 2017-06-15 |
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| 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 |
|---|---|---|---|---|
| 1952463531 | Michael Medley | Dentist | 400 Yauger Way Sw, Olympia, WA 98502-8139 | 2006-12-13 |
| 1588644413 | Michael Edward Werner | Dentist | 3425 Ensign Rd Ne, Suite 310, Olympia, WA 98506-5425 | 2006-01-18 |
| 1417241282 | Austin Rubel | Dentist | 3425 Ensign Rd Ne, Suite 310, Olympia, WA 98506-5425 | 2011-06-08 |
| 1720311442 | Ryan David Womack | Dentist | 400 Yauger Way Sw, Suite A, Olympia, WA 98502-8139 | 2009-09-14 |
| 1730310426 | Peter David Gauger | Dentist | 3425 Ensign Rd Ne, Suite 310, Olympia, WA 98506-5425 | 2009-07-29 |
| 1699989749 | Michael R Kelson, Dds, Pllc | Dentist | 3624 Ensign Rd Ne, Olympia, WA 98506-5074 | 2007-05-09 |
| 1407944614 | South Sound Oral Surgery Pllc | Dentist | 3425 Ensign Rd Ne, Suite 310, Olympia, WA 98506 | 2006-10-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023619657 | Washington Jaw and Facial Surgery Pllc | Dentist | 451 Duvall Ave Ne Ste 100, Renton, WA 98059-4675 | 2020-11-02 |
| 1952909145 | Calley Christie Dmd Pllc | Dentist | 275 Sw 160th St Ste 115, Burien, WA 98166-3003 | 2020-10-11 |
| 1679197016 | Tae Youn Dds Md Pllc | Dentist | 15808 Mill Creek Blvd Ste 202, Mill Creek, WA 98012-1500 | 2020-06-02 |
| 1417416728 | Sam Wise | Dentist | 1538 11th Ave Lowr Columbia, Longview, WA 98632 | 2019-03-16 |
| 1740744374 | Thompson Ferguson Schrack Pllc | Dentist | 7604 Ne 5th Ave Ste 114, Vancouver, WA 98665-8200 | 2019-01-28 |
| 1053875096 | John K Tidwell Dds and Elizabeth A Kutcipal Dds Pllc | Dentist | 1801 Nw Market St Ste 108, Seattle, WA 98107-3909 | 2019-01-23 |
| 1255803904 | Edwards, Johnson, Johnson & Johnson D.d.s., P.l.l.c. | Dentist | 601 S Carr Rd Ste 300, Renton, WA 98055-5840 | 2018-12-19 |
| 1104396969 | Mark Stivers, Dds, Inc., P.s. | Dentist | 12728 19th Ave Se Ste 101, Everett, WA 98208-6526 | 2018-12-04 |
| 1144797499 | Washington Jaw and Facial Surgery Pllc | Dentist | 1370 116th Ave Ne Ste 101, Bellevue, WA 98004-3825 | 2018-10-25 |
| 1780151027 | Washington Jaw and Facial Surgery Pllc | Dentist | 2111 N Northgate Way Ste 105, Seattle, WA 98133-9018 | 2018-10-25 |
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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.