Organization
FAMILY DENTISTRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER R KELLEY DDS (DENTIST)
(518) 642-2111
Entity
Organization
Contact information
Practice address
89 NORTH ST, GRANVILLE, NY 12832-1138
(518) 642-2111
(518) 642-2891
Mailing address
89 NORTH ST, GRANVILLE, NY 12832-1138
(518) 642-2111
(518) 642-2891
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02375744
—
NY
05
—
1010081
—
VT
Enumeration date
08/31/2005
Last updated
08/22/2020
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