Individual
DR. DIANE COLLETTE KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
2119 HAMILTON CREEK PKWY, SUITE 200, DACULA, GA 30019-3293
(678) 714-7011
(678) 714-8388
Mailing address
2119 HAMILTON CREEK PKWY, SUITE 200, DACULA, GA 30019-3293
(678) 714-7011
(678) 714-8388
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN012082
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN012082
DENTAL LICENSE NUMBER
GA
Enumeration date
02/08/2007
Last updated
07/09/2013
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