MEDICARE: KELLEY DENTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080N0001X	Neonatal-Perinatal Medicine Physician	113013	GA
2	208000000X	Pediatrics Physician	2023010219	MO
3	208000000X	Pediatrics Physician	2021029009	MO

General Provider Information

NPI Number	:	1255959946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY DENTON MD

Provider Business Mailing Address
First Line	:	WUSM PEDS, 1 CHILDRENS PL CB 8116
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1002
Country	:	US
Telephone Number	:	314-454-4826
Fax Number	:	314-454-4633

Provider Business Practice Location Address
First Line	:	WUSM PEDS, 1 CHILDRENS PL CB 8116
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1002
Country	:	US
Telephone Number	:	314-454-4826
Fax Number	:	314-454-4633

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2020
Last Update Date	:	05/14/2026

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Directions to “ KELLEY DENTON MD” Practice Location

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