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General NPI Number Information
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NPI Number | 1588124911
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Entity Type | Individual
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Provider Name | KELSEY GREENHALGH DDS
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Gender | Male
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Dates
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Enumeration Date | 03/21/2019
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 760 MONTAUK HWY STE 10
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City | CENTER MORICHES
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State | NY
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Zip | 11934-2230
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Country | US
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Telephone | 631-878-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 321 PINE HILLS DR
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City | MANORVILLE
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State | NY
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Zip | 11949-3454
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Country | US
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Telephone | 631-905-6295
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 12501
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 063396
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License Number State | NY
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