Provider Demographics
NPI:1821012881
Name:KELLING, TIMOTHY S (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:S
Last Name:KELLING
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BALMAIN CT
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-6486
Mailing Address - Country:US
Mailing Address - Phone:518-581-2808
Mailing Address - Fax:
Practice Address - Street 1:4 FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1514
Practice Address - Country:US
Practice Address - Phone:518-793-9424
Practice Address - Fax:518-793-9441
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0487231122300000X
NY2278311174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02348676Medicaid
NY02567155Medicaid