Provider Demographics
NPI:1942318555
Name:KELLY, JOSEPH C JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:C
Last Name:KELLY
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 SILVERSIDE ROAD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810
Mailing Address - Country:US
Mailing Address - Phone:302-475-5555
Mailing Address - Fax:302-475-5861
Practice Address - Street 1:2205 SILVERSIDE ROAD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810
Practice Address - Country:US
Practice Address - Phone:302-475-5555
Practice Address - Fax:302-475-5861
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00010861223G0001X
DEBK5934612122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1760786404OtherNPI
DE1000037979Medicaid