Healthcare Provider Details

I. General information

NPI: 1255771267
Provider Name (Legal Business Name): DAVID KELLOGG D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10081 BEACH VERBENA DR
RIVERVIEW FL
33578-5491
US

IV. Provider business mailing address

10081 BEACH VERBENA DR
RIVERVIEW FL
33578-5491
US

V. Phone/Fax

Practice location:
  • Phone: 813-741-1900
  • Fax: 813-741-1901
Mailing address:
  • Phone: 813-741-1900
  • Fax: 813-741-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN 20366
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: