Edward T Kelly IV, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

010536 Issued in CT

Practice address

114 Woodland St
Hartford, CT 06105-1208

Phone

(860) 714-4995

Fax

(860) 714-8005

NPI assigned

Jun 30, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: ekelly2386815@direct.trinity-health.org

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

{
    "created_epoch": "1309392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377216000000",
    "number": "1124315957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 WOODLAND ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061051208",
            "telephone_number": "860-714-4529",
            "fax_number": "860-714-8003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 WOODLAND ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061051208",
            "telephone_number": "860-714-4995",
            "fax_number": "860-714-8005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "EDWARD",
        "middle_name": "T",
        "name_suffix": "IV",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-30",
        "last_updated": "2013-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "010536",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004011201",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mariann Nocera Kelley, MD
• Kathleen Kelliher, PA
• Kristine Kelliher, MD
• Christine Stewart Kelly, APRN
• Donald R Kelly, MD
• Olivia Nicole Kelly, MD
• Jacob Kelner, DO
• Barry Dana Kels, M.D.
• Anita Kelsey, MD
• Audrey Maureen Kemp, AGPCNP-BC

• General Practice Dentistry in Hartford, CT
• Providers in Hartford, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.