Provider Demographics
NPI:1881759561
Name:DEMAREST, KELLY BLENKHORN (DMD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:BLENKHORN
Last Name:DEMAREST
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 1:31 CROWELL RD
Mailing Address - Street 2:
Mailing Address - City:SAGAMORE BEACH
Mailing Address - State:MA
Mailing Address - Zip Code:02562-2610
Mailing Address - Country:US
Mailing Address - Phone:508-888-1256
Mailing Address - Fax:
Practice Address - Street 1:15 CEDAR ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3009
Practice Address - Country:US
Practice Address - Phone:508-790-7801
Practice Address - Fax:508-775-5608
Is Sole Proprietor?:No
Enumeration Date:2006-12-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA189551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice