Provider Demographics
NPI:1356468508
Name:KELLEY, CAROLE J (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:J
Last Name:KELLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 LEAP CT
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1175
Mailing Address - Country:US
Mailing Address - Phone:614-777-1877
Mailing Address - Fax:614-777-1787
Practice Address - Street 1:4621 LEAP CT
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1175
Practice Address - Country:US
Practice Address - Phone:614-777-1877
Practice Address - Fax:614-777-1787
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16584122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist