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General NPI Number Information
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NPI Number | 1699769018
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Entity Type | Individual
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Provider Name | KEVIN DANIEL KIELY DMD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 06/22/2016
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Provider Practice Location Address
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Address Line | 5408 DISCOVERY PARK BLVD SUITE 101
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-2893
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Country | US
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Telephone | 757-208-0138
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Fax | 757-206-1981
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Provider Business Mailing Address
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Address Line | 149 OAK HOLW
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-8919
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Country | US
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Telephone | 757-208-0138
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Fax | 757-206-1981
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0401007303
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License Number State | VA
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