Provider Demographics
NPI:1609008648
Name:HURSH, KELLEY ANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:ANNE
Last Name:HURSH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KELLEY
Other - Middle Name:ANNE
Other - Last Name:ELTRINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:UNIT 3690
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09126-3690
Mailing Address - Country:US
Mailing Address - Phone:314-452-8340
Mailing Address - Fax:
Practice Address - Street 1:UNIT 3690
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09126-3690
Practice Address - Country:US
Practice Address - Phone:314-452-8340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037967122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist