Provider Demographics
NPI:1760531388
Name:KEVIN M. KELAHER, D.M.D., P.C.
Entity Type:Organization
Organization Name:KEVIN M. KELAHER, D.M.D., P.C.
Other - Org Name:HIGHLAND DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELAHER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-740-5135
Mailing Address - Street 1:100 HIGHLAND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2702
Mailing Address - Country:US
Mailing Address - Phone:978-740-5135
Mailing Address - Fax:978-740-5105
Practice Address - Street 1:100 HIGHLAND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2702
Practice Address - Country:US
Practice Address - Phone:978-740-5135
Practice Address - Fax:978-740-5105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA123611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA967167OtherUNITED CONCORDIA INS. CO.
MAX11034OtherBLUECROSS BLUESHIELD