Provider Demographics
NPI:1679682751
Name:JOSEPH T. KELLY DMD PC
Entity Type:Organization
Organization Name:JOSEPH T. KELLY DMD PC
Other - Org Name:KELLY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-587-4787
Mailing Address - Street 1:103 WEST GROVE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2019
Mailing Address - Country:US
Mailing Address - Phone:570-587-4787
Mailing Address - Fax:570-586-2375
Practice Address - Street 1:103 WEST GROVE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-2019
Practice Address - Country:US
Practice Address - Phone:570-587-4787
Practice Address - Fax:570-586-2375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028710L122300000X
PADS017660L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty