Individual
DR. DAVID RANDOLPH KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1941 EUCLID AVE, BRISTOL, VA 24201-3607
(276) 669-0112
(276) 669-6922
Mailing address
1941 EUCLID AVE, BRISTOL, VA 24201-3607
(276) 669-0112
(276) 669-6922
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401006167
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0064919
BCBS
TN
01
—
021225
ANTHEM
—
05
—
9178719
—
VA
Enumeration date
07/20/2006
Last updated
07/08/2007
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