Provider Demographics
NPI:1326260936
Name:HU, KELLEY ANNE (DDS)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:ANNE
Last Name:HU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:ANNE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:13539 FLOWERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-6347
Mailing Address - Country:US
Mailing Address - Phone:301-535-2238
Mailing Address - Fax:
Practice Address - Street 1:13539 FLOWERFIELD DR
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-6347
Practice Address - Country:US
Practice Address - Phone:301-535-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014113771223G0001X
MD136181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice