Provider Demographics
NPI:1851459028
Name:KELLY, EMILY EARLE (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:EARLE
Last Name:KELLY
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4607 BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3513
Mailing Address - Country:US
Mailing Address - Phone:502-802-3585
Mailing Address - Fax:502-937-3998
Practice Address - Street 1:7214 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-3720
Practice Address - Country:US
Practice Address - Phone:502-937-3998
Practice Address - Fax:502-937-3998
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY79641223E0200X
IN12010894A1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics