Provider Demographics
NPI:1568722544
Name:KELLEY, AMBER LYN (RHD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LYN
Last Name:KELLEY
Suffix:
Gender:F
Credentials:RHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89433-7542
Mailing Address - Country:US
Mailing Address - Phone:775-379-7478
Mailing Address - Fax:
Practice Address - Street 1:333 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-1645
Practice Address - Country:US
Practice Address - Phone:775-323-3892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101758124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist