Provider Demographics
NPI:1205938586
Name:DENNIS, KELLE M (DDS)
Entity type:Individual
Prefix:DR
First Name:KELLE
Middle Name:M
Last Name:DENNIS
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 1:3040 BRIARCLIFF RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2602
Mailing Address - Country:US
Mailing Address - Phone:404-254-5196
Mailing Address - Fax:404-254-5612
Practice Address - Street 1:3040 BRIARCLIFF RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2602
Practice Address - Country:US
Practice Address - Phone:404-254-5196
Practice Address - Fax:404-254-5612
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014732122300000X
PADS029174L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015021500006Medicaid
NJ0068799Medicaid