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General NPI Number Information
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NPI Number | 1679797930
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY OF LOS ALTOS
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 731 ALTOS OAKS DR
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City | LOS ALTOS
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State | CA
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Zip | 94024-5402
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Country | US
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Telephone | 650-948-6884
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Fax | 650-948-7244
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Provider Business Mailing Address
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Address Line | 731 ALTOS OAKS DR
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City | LOS ALTOS
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State | CA
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Zip | 94024-5402
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Country | US
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Telephone | 650-948-6884
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Fax | 650-948-7244
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Authorized Official
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Title or Position | DENTIST
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Name | JAMES KELLY
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Credential | DDS
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Telephone | 650-948-6884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 30395
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 38101
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 21718
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License Number State | CA
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