# TERRY M. KELLY DMD PA

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

## Provider details

- **NPI number:** 1972640563
- **Authorized official:** DR. TERRY MICHAEL KELLY DMD (OWNER DENTIST)
- **Authorized official phone:** (813) 745-3968

## Contact information

- **Practice address:** 12902 MAGNOLIA DRIVE, HEAD AND NECK CLINIC, TAMPA, FL 33612
- **Practice address phone:** (813) 979-3968
- **Practice address fax:** (813) 745-7464
- **Mailing address:** 701 S HOWARD AVE STE 106-307, TAMPA, FL 33606-2473
- **Mailing address phone:** (813) 745-3968
- **Mailing address fax:** (813) 745-7464

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0700X | Prosthodontics | DN11407 | FL | Yes |

## Other

- **Enumeration date:** 01/31/2007
- **Last updated:** 08/22/2020