Provider Demographics
NPI:1336400621
Name:CARR, KELLY MARIE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MARIE
Last Name:CARR
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10401 SAWMILL PKWY
Mailing Address - Street 2:SUITE 50
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7451
Mailing Address - Country:US
Mailing Address - Phone:614-932-9356
Mailing Address - Fax:
Practice Address - Street 1:10401 SAWMILL PKWY
Practice Address - Street 2:SUITE 50
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7451
Practice Address - Country:US
Practice Address - Phone:614-932-9356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-03
Last Update Date:2012-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0236021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics