# KENNETH R. KELLY, D.D.S, P.C.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1194734335
- **Authorized official:** DR. KENNETH R. KELLY D.D.S. (PRESIDENT/PRACTIONER)
- **Authorized official phone:** (423) 283-4175

## Contact information

- **Practice address:** 402 PRINCETON RD, SUITE A, JOHNSON CITY, TN 37601-2057
- **Practice address phone:** (423) 283-4175
- **Practice address fax:** (423) 283-0443
- **Mailing address:** 402 PRINCETON RD, SUITE A, JOHNSON CITY, TN 37601-2057
- **Mailing address phone:** (423) 283-4175
- **Mailing address fax:** (423) 283-0443

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DS2230 | TN | Yes |

## Other

- **Enumeration date:** 08/05/2006
- **Last updated:** 08/22/2020