Provider Demographics
NPI:1255486064
Name:KELP, JOHN KAVIN (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KAVIN
Last Name:KELP
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JK
Other - Middle Name:
Other - Last Name:KELP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4201 BEE CAVE RD
Mailing Address - Street 2:SUITE C208
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6458
Mailing Address - Country:US
Mailing Address - Phone:512-306-0115
Mailing Address - Fax:512-306-1125
Practice Address - Street 1:4201 BEE CAVE RD
Practice Address - Street 2:SUITE C208
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6458
Practice Address - Country:US
Practice Address - Phone:512-306-0115
Practice Address - Fax:512-306-1125
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice