# MARIE PETTERS KELLY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114417045
- **Authorized official:** DANIEL KELLY (GM)
- **Authorized official phone:** (717) 925-4327

## Contact information

- **Practice address:** 1670 LINCOLN HWY E, LANCASTER, PA 17602-2663
- **Practice address phone:** (717) 394-1067
- **Mailing address:** 1670 LINCOLN HWY E, LANCASTER, PA 17602-2663
- **Mailing address phone:** (717) 394-1067

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | DS025788L | PA | Yes |
| 261QD0000X | Dental Clinic/Center | DS035577 | PA | — |
| 261QD0000X | Dental Clinic/Center | DS040000 | PA | — |

## Other

- **Enumeration date:** 05/16/2018
- **Last updated:** 05/16/2018