Provider Demographics
NPI:1407958119
Name:KELLY, PATRICIA ROSE (DMD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ROSE
Last Name:KELLY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4540 SAND POINT WAY NE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3941
Mailing Address - Country:US
Mailing Address - Phone:206-522-2212
Mailing Address - Fax:206-522-9494
Practice Address - Street 1:4540 SAND POINT WAY NE
Practice Address - Street 2:SUITE 360
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105
Practice Address - Country:US
Practice Address - Phone:206-522-2212
Practice Address - Fax:206-522-9494
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2010-08-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WADR00001411223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery