Provider Demographics
NPI:1528193976
Name:KELLEY, DONALD L II (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:L
Last Name:KELLEY
Suffix:II
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3296 BRIGHTON PLACE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2313
Mailing Address - Country:US
Mailing Address - Phone:859-523-3324
Mailing Address - Fax:
Practice Address - Street 1:216 FOUNTAIN CT
Practice Address - Street 2:SUITE 140
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1888
Practice Address - Country:US
Practice Address - Phone:859-685-1068
Practice Address - Fax:859-685-1069
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY71301223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics