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General NPI Number Information
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NPI Number | 1992888242
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Entity Type | Individual
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Provider Name | ANDREW WAYNE KELLY DDS
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 5509B W FRIENDLY AVE STE 200
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City | GREENSBORO
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State | NC
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Zip | 27410-4279
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Country | US
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Telephone | 336-766-7966
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Fax | 877-840-4367
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Provider Business Mailing Address
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Address Line | 137 N HIDDENBROOKE DR
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City | ADVANCE
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State | NC
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Zip | 27006-7299
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Country | US
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Telephone | 336-766-7966
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Fax | 336-940-5346
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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 | 35919
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7350
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License Number State | NC
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