Provider Demographics
NPI:1346845500
Name:KELLEY ORTHODONTICS, PC
Entity Type:Organization
Organization Name:KELLEY ORTHODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-856-9323
Mailing Address - Street 1:1065 JOHNNIE DODDS BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-6153
Mailing Address - Country:US
Mailing Address - Phone:843-856-9323
Mailing Address - Fax:843-881-1878
Practice Address - Street 1:1065 JOHNNIE DODDS BLVD STE E
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-6153
Practice Address - Country:US
Practice Address - Phone:843-856-9323
Practice Address - Fax:843-881-1878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty