Individual
DEREK KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS024337
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011290810009
—
PA
05
—
0011290810011
—
PA
05
—
0011290810017
—
PA
05
—
0011290810018
—
PA
05
—
0011290810019
—
PA
05
—
0011290810021
—
PA
Enumeration date
04/04/2006
Last updated
12/12/2013
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