Provider Demographics
NPI:1871503847
Name:KELLY, BARBARA A (DMD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:A
Last Name:KELLY
Suffix:
Gender:F
Credentials:DMD
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Mailing Address - Street 1:40315 JUNCTION DR
Mailing Address - Street 2:STE D
Mailing Address - City:OAKHURST
Mailing Address - State:CA
Mailing Address - Zip Code:93644-9159
Mailing Address - Country:US
Mailing Address - Phone:559-658-7715
Mailing Address - Fax:559-658-7714
Practice Address - Street 1:13847 E 14TH STREET
Practice Address - Street 2:SUITE 111
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578
Practice Address - Country:US
Practice Address - Phone:510-352-6262
Practice Address - Fax:510-351-6944
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2016-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA36950122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist