Provider Demographics
NPI:1093817561
Name:KELLY, JAMES M (DDS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:KELLY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2999 N. 44TH ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018
Mailing Address - Country:US
Mailing Address - Phone:602-954-1901
Mailing Address - Fax:602-954-1907
Practice Address - Street 1:2999 N. 44TH ST
Practice Address - Street 2:SUITE 260
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018
Practice Address - Country:US
Practice Address - Phone:602-954-1901
Practice Address - Fax:602-954-1907
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023440L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice