Provider Demographics
NPI:1992008908
Name:KELLY, ESTELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ESTELLE
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E 68TH ST STE 208
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-5867
Mailing Address - Country:US
Mailing Address - Phone:212-744-1333
Mailing Address - Fax:
Practice Address - Street 1:20 E 68TH ST STE 208
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-5867
Practice Address - Country:US
Practice Address - Phone:212-744-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0496741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice