Organization
DIANE C KELLY DMD, PC
Active
Other names
Childrens Dentistry at Hamilton Mill & Gainesville
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE C KELLY DMD (OWNER - AND PROVIDER)
(678) 714-7011
Entity
Organization
Contact information
Practice address
655 JESSE JEWELL PKWY SE, GAINESVILLE, GA 30501
(770) 539-9110
(678) 714-8388
Mailing address
655 JESSE JEWELL PKWY SE, GAINESVILLE, GA 30501
(770) 539-9110
(678) 714-8388
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DNO12082
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000046582Y
—
GA
05
—
000851727B
—
GA
05
—
186794814A
—
GA
05
—
191450941A
—
GA
05
—
218323780A
—
GA
05
—
390489607J
—
GA
05
—
514725717B
—
GA
05
—
609963109E
—
GA
05
—
609963109L
—
GA
05
—
919057925B
—
GA
Enumeration date
04/02/2008
Last updated
08/19/2008
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