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NPI Code Detail

MEDICARE: KATE KELLY DDS INC

MEDICARE: KATE KELLY DDS INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist30022338OH

General Provider Information

NPI Number : 1922545813
Entity Type Code : Organization
Provider Name (Legal Business Name) : KATE KELLY DDS INC
Provider Business Mailing Address
First Line : 2750 DOVER CENTER ROAD
Second Line :
City : WESTLAKE
State : OH
Zip : 44145
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2750 DOVER CENTER RD
Second Line :
City : WESTLAKE
State : OH
Zip : 44145-4501
Country : US
Telephone Number : 440-835-7272
Fax Number :
Authorized Official
Title or Position : OWNER
Name : KATE KELLY
Credential : DDS
Telephone Number : 440-835-7272
Provider Enumeration Date : 01/30/2017
Last Update Date : 01/30/2017

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