Organization
KENNETH R. KELLY, D.D.S, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH R. KELLY D.D.S. (PRESIDENT/PRACTIONER)
(423) 283-4175
Entity
Organization
Contact information
Practice address
402 PRINCETON RD, SUITE A, JOHNSON CITY, TN 37601-2057
(423) 283-4175
(423) 283-0443
Mailing address
402 PRINCETON RD, SUITE A, JOHNSON CITY, TN 37601-2057
(423) 283-4175
(423) 283-0443
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS2230
TN
Other
Enumeration date
08/05/2006
Last updated
08/22/2020
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