# A W KELLY DDS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Dental Center of the Carolinas
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932611092
- **Authorized official:** DR. ANDREW WAYNE KELLY DDS (OWNER/ MANAGER)
- **Authorized official phone:** (336) 766-7966

## Contact information

- **Practice address:** 4550 COUNTRY CLUB RD, WINSTON SALEM, NC 27104-3518
- **Practice address phone:** (333) 766-7966
- **Practice address fax:** (877) 840-4367
- **Mailing address:** 137 N HIDDENBROOKE DR, ADVANCE, NC 27006-7299
- **Mailing address phone:** (336) 766-7966

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 07350 | NC | Yes |

## Other

- **Enumeration date:** 10/30/2017
- **Last updated:** 08/14/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1992888242 | — | NC |