Provider Demographics
NPI:1588654073
Name:DAVID W. KELLINY, DDS, INC.
Entity Type:Organization
Organization Name:DAVID W. KELLINY, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WASFY
Authorized Official - Last Name:KELLINY
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, DDS
Authorized Official - Phone:310-793-2020
Mailing Address - Street 1:22920 CRENSHAW BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3023
Mailing Address - Country:US
Mailing Address - Phone:310-793-2020
Mailing Address - Fax:310-793-2008
Practice Address - Street 1:22920 CRENSHAW BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3023
Practice Address - Country:US
Practice Address - Phone:310-793-2020
Practice Address - Fax:310-793-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA433541223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty