Provider Demographics
NPI:1073745253
Name:KELLY, ALYSON HOOPER (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALYSON
Middle Name:HOOPER
Last Name:KELLY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ALYSON
Other - Middle Name:MARIE
Other - Last Name:HOOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:481 LANDSDOWNE CIR
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-3912
Mailing Address - Country:US
Mailing Address - Phone:239-872-9832
Mailing Address - Fax:
Practice Address - Street 1:16717 US HIGHWAY 17 N
Practice Address - Street 2:SUITE 224
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-3696
Practice Address - Country:US
Practice Address - Phone:910-270-0728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN187651223G0001X
NC98621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice