Provider Demographics
NPI:1871646471
Name:JAMES, KELLY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8755 CHAFFEE RD.
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:TN
Mailing Address - Zip Code:38014
Mailing Address - Country:US
Mailing Address - Phone:901-382-9704
Mailing Address - Fax:901-382-9706
Practice Address - Street 1:8755 CHAFFEE RD.
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:TN
Practice Address - Zip Code:38014
Practice Address - Country:US
Practice Address - Phone:901-382-9704
Practice Address - Fax:901-382-9706
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN84091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice