Provider Demographics
NPI:1033210240
Name:KELLEY, JAMES E (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:KELLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5555 N MESA ST STE 300
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5487
Mailing Address - Country:US
Mailing Address - Phone:915-581-6526
Mailing Address - Fax:915-581-8284
Practice Address - Street 1:5555 N MESA ST STE 300
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5487
Practice Address - Country:US
Practice Address - Phone:915-581-6526
Practice Address - Fax:915-581-8284
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics