Provider Demographics
NPI:1528004181
Name:GINNARD, KELLY M (DMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:M
Last Name:GINNARD
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 1:155 DOW ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1299
Mailing Address - Country:US
Mailing Address - Phone:603-296-2329
Mailing Address - Fax:603-622-8350
Practice Address - Street 1:155 DOW ST
Practice Address - Street 2:SUITE 401
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1299
Practice Address - Country:US
Practice Address - Phone:603-296-2329
Practice Address - Fax:603-622-8350
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH25201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice