MEDICARE: DR. KELLY NEDIMYER ACKLEY D.M.D.

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	DN19689	FL

General Provider Information

NPI Number	:	1457612228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY NEDIMYER ACKLEY D.M.D.

Provider Business Mailing Address
First Line	:	5012 WESTSHORE DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-3042
Country	:	US
Telephone Number	:	305-731-3267
Fax Number	:	352-666-1148

Provider Business Practice Location Address
First Line	:	1530 PINEHURST DR
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34606-4555
Country	:	US
Telephone Number	:	352-683-7668
Fax Number	:	352-666-1148

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

Provider Enumeration Date	:	06/07/2012
Last Update Date	:	06/07/2012

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