Organization
ROY WILLIAM KELLY JR DDS PA
Active
Other names
Kelly and Kelly
Organization subpart
No
Provider details
NPI number
Authorized official
DR. R WILLIAM KELLY JR. DDS (PRESIDENT OWNER)
(704) 867-1671
Entity
Organization
Contact information
Practice address
1601C EAST GARRISON BLVD, GASTONIA, NC 28054
(704) 867-1671
Mailing address
1601C EAST GARRISON BLVD, GASTONIA, NC 28054
(704) 867-1671
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3944
NC
1223G0001X
General Practice Dentistry
3944
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8994825
—
NC
Enumeration date
09/28/2006
Last updated
08/11/2008
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