Provider Demographics
NPI:1760786404
Name:JOSEPH C. KELLY, JR., D.D.S.,PA
Entity Type:Organization
Organization Name:JOSEPH C. KELLY, JR., D.D.S.,PA
Other - Org Name:GRAYLYN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-475-5555
Mailing Address - Street 1:2205 SILVERSIDE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4534
Mailing Address - Country:US
Mailing Address - Phone:302-475-5555
Mailing Address - Fax:302-475-5861
Practice Address - Street 1:2205 SILVERSIDE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4534
Practice Address - Country:US
Practice Address - Phone:302-475-5555
Practice Address - Fax:302-475-5861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty