| Kenneth R. Kelly, D.d.s, P.c. | |
|
402 Princeton Rd Suite A Johnson City TN 37601-2057 | |
| (423) 283-4175 | |
| (423) 283-0443 |
| Full Name | Kenneth R. Kelly, D.d.s, P.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 402 Princeton Rd, Johnson City, Tennessee |
| Authorized Official Name and Position | Kenneth R. Kelly (PRESIDENT/PRACTIONER) |
| Authorized Official Contact | 4232834175 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenneth R. Kelly, D.d.s, P.c. 402 Princeton Rd Suite A Johnson City TN 37601-2057 Ph: (423) 283-4175 | Kenneth R. Kelly, D.d.s, P.c. 402 Princeton Rd Suite A Johnson City TN 37601-2057 Ph: (423) 283-4175 |
| NPI Number | 1194734335 |
|---|---|
| Provider Enumeration Date | 08/05/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194734335 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DS2230 (Tennessee) | Primary |
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