Provider Demographics
NPI:1194463927
Name:WORMAN, KELLI E (PHDHP, RDH)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:E
Last Name:WORMAN
Suffix:
Gender:F
Credentials:PHDHP, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 GERHART LN
Mailing Address - Street 2:
Mailing Address - City:TELFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18969-2417
Mailing Address - Country:US
Mailing Address - Phone:215-527-5034
Mailing Address - Fax:
Practice Address - Street 1:669 GERHART LN
Practice Address - Street 2:
Practice Address - City:TELFORD
Practice Address - State:PA
Practice Address - Zip Code:18969-2417
Practice Address - Country:US
Practice Address - Phone:215-527-5034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPHDH001154124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist