Individual
ANDREA KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2908 AUBURN RD, HUNTINGTON, WV 25704-2715
(304) 781-5800
Mailing address
PO BOX 1680, HUNTINGTON, WV 25717-1680
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3487
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2408513
—
OH
05
—
4002196000
—
WV
05
—
60002029
—
KY
Enumeration date
01/19/2006
Last updated
05/28/2024
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