Individual
DR. JOHN ROBERT KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
263 FARMINGTON AVE, DEPARTMENT OF RECONSTRUCTIVE SCIENCES, FARMINGTON, CT 06030-1615
(860) 679-3747
(860) 679-1370
Mailing address
263 FARMINGTON AVE, DEPARTMENT OF RECONSTRUCTIVE SCIENCES, FARMINGTON, CT 06030-1615
(860) 679-3747
(860) 679-1370
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
008833
CT
1223G0001X
General Practice Dentistry
Primary
008833
CT
Other
Enumeration date
01/03/2013
Last updated
03/06/2015
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