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General NPI Number Information
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NPI Number | 1457612228
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Entity Type | Individual
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Provider Name | KELLY NEDIMYER ACKLEY D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/07/2012
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Last Update Date | 06/07/2012
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Provider Practice Location Address
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Address Line | 1530 PINEHURST DR
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City | SPRING HILL
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State | FL
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Zip | 34606-4555
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Country | US
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Telephone | 352-683-7668
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Fax | 352-666-1148
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Provider Business Mailing Address
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Address Line | 5012 WESTSHORE DR
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-3042
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Country | US
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Telephone | 305-731-3267
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Fax | 352-666-1148
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN19689
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License Number State | FL
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