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Organization
TIMOTHY M. KELLY, DMD, PA
Active
Organization
TIMOTHY M. KELLY, DMD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY M KELLY DMD, PA (OWNER/DENTIST)
(505) 256-1770
Entity
Organization
Contact information
Practice address
1441 CARLISLE BLVD NE, SUITE D, ALBUQUERQUE, NM 87110-5610
(505) 256-1770
(505) 255-0220
Mailing address
1441 CARLISLE BLVD NE, SUITE D, ALBUQUERQUE, NM 87110-5610
(505) 256-1770
(505) 255-0220
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
1413
NM
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BC3200X
Customized Equipment (DME)
1413
NM
Other
Enumeration date
12/10/2015
Last updated
02/19/2021
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