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Individual
DR. ANDREW WAYNE KELLY
Active
Individual
DR. ANDREW WAYNE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
35919
CA
1223G0001X
General Practice Dentistry
Primary
7350
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1932611092
—
NC
01
—
82-3139362
IRS
—
Enumeration date
10/23/2006
Last updated
08/14/2023
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