NPIMap

Organization Active NPI

Marie Petters Kelly

  • Dental Clinic/Center
  • Lancaster, PA
National Provider Identifier
1114417045
Registry record updated May 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
DS025788L Issued in PA
Legal business name
MARIE PETTERS KELLY
Practice address
1670 Lincoln Hwy E
Lancaster, PA 17602-2663
Phone
(717) 394-1067
NPI assigned
May 16, 2018
Last updated
May 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Daniel Kelly
Title
GM
Phone
(717) 925-4327

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X DS025788L PA Primary
Dental Clinic/Center 261QD0000X DS035577 PA
Dental Clinic/Center 261QD0000X DS040000 PA

Addresses

Primary practice location

1670 Lincoln Hwy E
Lancaster, PA 17602-2663

Mailing address

1670 Lincoln Hwy E
Lancaster, PA 17602-2663
Phone (717) 394-1067

Other identifiers 3

IdentifierTypeStateIssuer
DS040000OtherPADENTAL LICENSE
DS035577OtherPADENTAL LICENSE
DS025788LOtherPADENTAL LICENSE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1526428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526428800000",
    "number": "1114417045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1670 LINCOLN HWY E",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176022663",
            "telephone_number": "717-394-1067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1670 LINCOLN HWY E",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176022663",
            "telephone_number": "717-394-1067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIE PETTERS KELLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-16",
        "last_updated": "2018-05-16",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "GM",
        "authorized_official_telephone_number": "717-925-4327"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "PA",
            "license": "DS025788L",
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "PA",
            "license": "DS035577",
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "PA",
            "license": "DS040000",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "DS040000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "DS035577",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "DS025788L",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lancaster, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.