Provider Demographics
NPI:1326154782
Name:KALMAR, KELLY LIZA (DMD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LIZA
Last Name:KALMAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-6912
Mailing Address - Country:US
Mailing Address - Phone:631-673-0670
Mailing Address - Fax:631-673-0791
Practice Address - Street 1:62 GREEN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6912
Practice Address - Country:US
Practice Address - Phone:631-673-0670
Practice Address - Fax:631-673-0791
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047866122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0062159Medicaid