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Organization
KELLY DENTAL ARTS
Active
Organization
KELLY DENTAL ARTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAWN M POLI DMD (MANAGING MEMBER)
(814) 404-8462
Entity
Organization
Contact information
Practice address
277 WHITE HORSE PIKE, SUITE 104, ATCO, NJ 08004-2275
(814) 404-8462
Mailing address
277 WHITE HORSE PIKE, SUITE 104, ATCO, NJ 08004-2275
(814) 404-8462
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22DI02260700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013082189
INDIVIDUAL NPI NUMBER OF DENTIST
—
01
—
1306076617
INDIVIDUAL NPI NUMBER OF DENTIST
—
Enumeration date
08/16/2011
Last updated
08/16/2011
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