Provider Demographics
NPI:1659901973
Name:KELLY J RIGNEY DDS PLLC
Entity Type:Organization
Organization Name:KELLY J RIGNEY DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:JIM
Authorized Official - Last Name:RIGNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-657-3536
Mailing Address - Street 1:3552 BRADFORD SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6307
Mailing Address - Country:US
Mailing Address - Phone:734-657-3536
Mailing Address - Fax:
Practice Address - Street 1:21800 PONTIAC TRL STE 100
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-7400
Practice Address - Country:US
Practice Address - Phone:248-437-8300
Practice Address - Fax:248-437-8066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-26
Last Update Date:2020-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental