MEDICARE: DR. ANN KELLEY D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DE00009582	WA

General Provider Information

NPI Number	:	1184718777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANN KELLEY D.D.S.

Provider Business Mailing Address
First Line	:	12308 NE 144TH ST
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98034-4503
Country	:	US
Telephone Number	:	425-821-9191
Fax Number	:	425-400-9760

Provider Business Practice Location Address
First Line	:	12308 NE 144TH STREET
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98034
Country	:	US
Telephone Number	:	425-821-9191
Fax Number	:	425-825-7456

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	04/21/2026

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