Individual
DR. JOSEPH T. KELLY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
103 W GROVE ST, CLARKS SUMMIT, PA 18411-2062
(570) 587-4787
(570) 586-2375
Mailing address
103 W GROVE ST, CLARKS SUMMIT, PA 18411-2062
(570) 587-4787
(570) 586-2375
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DS028710L
PA
1223P0300X
Periodontics
DS028710L
PA
1223P0700X
Prosthodontics
Primary
DS028710L
PA
Other
Enumeration date
07/24/2013
Last updated
07/24/2013
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