MEDICARE: DAVID KELLOGG D.D.S., M.S.

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	1223E0200X	Endodontics	DN 20366	FL

General Provider Information

NPI Number	:	1255771267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID KELLOGG D.D.S., M.S.

Provider Business Mailing Address
First Line	:	10081 BEACH VERBENA DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-5491
Country	:	US
Telephone Number	:	813-741-1900
Fax Number	:	813-741-1901

Provider Business Practice Location Address
First Line	:	10081 BEACH VERBENA DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-5491
Country	:	US
Telephone Number	:	813-741-1900
Fax Number	:	813-741-1901

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

Provider Enumeration Date	:	07/05/2013
Last Update Date	:	01/15/2026

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