# KELLY DENTAL ARTS

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

## Provider details

- **NPI number:** 1578842951
- **Authorized official:** DR. DAWN M POLI DMD (MANAGING MEMBER)
- **Authorized official phone:** (814) 404-8462

## Contact information

- **Practice address:** 277 WHITE HORSE PIKE, SUITE 104, ATCO, NJ 08004-2275
- **Practice address phone:** (814) 404-8462
- **Mailing address:** 277 WHITE HORSE PIKE, SUITE 104, ATCO, NJ 08004-2275
- **Mailing address phone:** (814) 404-8462

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 22DI02260700 | NJ | Yes |

## Other

- **Enumeration date:** 08/16/2011
- **Last updated:** 08/16/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1013082189 | INDIVIDUAL NPI NUMBER OF DENTIST | — |
| 01 | — | 1306076617 | INDIVIDUAL NPI NUMBER OF DENTIST | — |