Individual
DEREK KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1597 WASHINGTON PIKE STE A5, BRIDGEVILLE, PA 15017-2881
(412) 279-4800
(412) 279-7119
Mailing address
926 GREAT POND DR, SUITE 2003, ALTAMONTE SPRINGS, FL 32714-7244
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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