Provider Demographics
NPI:1801184544
Name:WHELAN, KELLY B (DMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:B
Last Name:WHELAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 NORTHEASTERN BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-3154
Mailing Address - Country:US
Mailing Address - Phone:603-521-8411
Mailing Address - Fax:
Practice Address - Street 1:57 NORTHEASTERN BLVD STE 201
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-3154
Practice Address - Country:US
Practice Address - Phone:603-521-8411
Practice Address - Fax:603-518-5170
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3851122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist