Healthcare Provider Details

I. General information

NPI: 1477585651
Provider Name (Legal Business Name): CHERYL A. KELLEY D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 WHITE SPRUCE BLVD
ROCHESTER NY
14623-1604
US

IV. Provider business mailing address

370 WHITE SPRUCE BLVD
ROCHESTER NY
14623-1604
US

V. Phone/Fax

Practice location:
  • Phone: 585-424-5005
  • Fax: 585-475-0096
Mailing address:
  • Phone: 585-424-5005
  • Fax: 585-475-0096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number036886
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: