# KELLY FAMILY DENTISTRY, PC

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

## Provider details

- **NPI number:** 1457620783
- **Authorized official:** CHRISTIAN H KELLY DDS (OWNER/DENTIST)
- **Authorized official phone:** (812) 683-1112

## Contact information

- **Practice address:** 1690 N MAIN STREET, HUNTINGBURG, IN 47542
- **Practice address phone:** (812) 683-1112
- **Practice address fax:** (888) 958-7816
- **Mailing address:** 1690 N MAIN STREET, HUNTINGBURG, IN 47542
- **Mailing address phone:** (812) 683-1112
- **Mailing address fax:** (888) 958-7816

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12011133A | IN | Yes |

## Other

- **Enumeration date:** 12/15/2011
- **Last updated:** 08/22/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200902290A | — | IN |