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General NPI Number Information
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NPI Number | 1184892085
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Entity Type | Individual
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Provider Name | EILEEN ANN KELLEY D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 349 NILES CORTLAND RD NE
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City | WARREN
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State | OH
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Zip | 44484-1976
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Country | US
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Telephone | 330-856-5520
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Fax | 330-856-6481
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Provider Business Mailing Address
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Address Line | 349 NILES CORTLAND RD NE
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City | WARREN
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State | OH
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Zip | 44484-1976
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Country | US
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Telephone | 330-856-5520
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Fax | 330-856-6481
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 20539DL
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License Number State | OH
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