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General NPI Number Information
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NPI Number | 1346845500
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Entity Type | Organization
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Legal Business Name | KELLEY ORTHODONTICS, PC
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Dates
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Enumeration Date | 12/03/2020
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 1065 JOHNNIE DODDS BLVD STE E
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City | MT PLEASANT
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State | SC
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Zip | 29464-6153
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Country | US
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Telephone | 843-856-9323
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Fax | 843-881-1878
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Provider Business Mailing Address
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Address Line | 1065 JOHNNIE DODDS BLVD STE E
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City | MT PLEASANT
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State | SC
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Zip | 29464-6153
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Country | US
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Telephone | 843-856-9323
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Fax | 843-881-1878
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Authorized Official
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Title or Position | PRIMARY DOCTOR
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Name | DR. JAMES E KELLEY II
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Credential | DMD
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Telephone | 843-856-9323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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