Provider Demographics
NPI:1598375412
Name:O'KELLY, ALYSE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALYSE
Middle Name:
Last Name:O'KELLY
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 1:115 ROUND HILL RD
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-2607
Mailing Address - Country:US
Mailing Address - Phone:310-418-9518
Mailing Address - Fax:
Practice Address - Street 1:355 GAP NEWPORT PIKE
Practice Address - Street 2:
Practice Address - City:CHRISTIANA
Practice Address - State:PA
Practice Address - Zip Code:17509-9685
Practice Address - Country:US
Practice Address - Phone:610-593-2818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0428721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice