Individual
EDWARD T KELLY IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
114 WOODLAND ST, HARTFORD, CT 06105-1208
(860) 714-4995
(860) 714-8005
Mailing address
114 WOODLAND ST, HARTFORD, CT 06105-1208
(860) 714-4529
(860) 714-8003
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
010536
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004011201
—
CT
Enumeration date
06/30/2011
Last updated
08/23/2013
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