Individual
DR. JOHN R KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1019 GHANER RD STE A, PORT MATILDA, PA 16870-7201
(814) 238-7120
(814) 238-2981
Mailing address
1019 GHANER RD STE A, PORT MATILDA, PA 16870-7201
(814) 238-7120
(814) 238-2981
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DS-019843-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005104610001
—
PA
Enumeration date
04/11/2007
Last updated
06/16/2014
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