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General NPI Number Information
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NPI Number | 1871503847
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Entity Type | Individual
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Provider Name | BARBARA A KELLY DMD
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Gender | Female
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 02/22/2016
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Provider Practice Location Address
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Address Line | 13847 E 14TH STREET SUITE 111
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City | SAN LEANDRO
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State | CA
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Zip | 94578
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Country | US
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Telephone | 510-352-6262
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Fax | 510-351-6944
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Provider Business Mailing Address
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Address Line | 40315 JUNCTION DR STE D
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City | OAKHURST
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State | CA
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Zip | 93644-9159
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Country | US
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Telephone | 559-658-7715
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Fax | 559-658-7714
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 36950
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License Number State | CA
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