Individual
MARIE PETTERS KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1670 LINCOLN HWY E, LANCASTER, PA 17602-2663
(717) 394-1067
Mailing address
1670 LINCOLN HWY E, LANCASTER, PA 17602-2663
(717) 394-1067
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
7583
NC
1223G0001X
General Practice Dentistry
Primary
DS025788L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DS025788L
PA DENTIST LICENSE
PA
Enumeration date
08/31/2006
Last updated
04/24/2018
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