Kenneth R. Kelly, D.D.S, P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS2230 Issued in TN

Legal business name

KENNETH R. KELLY, D.D.S, P.C.

Practice address

402 Princeton Rd
Suite a
Johnson City, TN 37601-2057

Phone

(423) 283-4175

Fax

(423) 283-0443

NPI assigned

Aug 5, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Kenneth R. Kelly, D.D.S.NPI 1396914990

Title

President/Practioner

Phone

(423) 283-4175

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kenneth Raymond Kelly, DDS

  • Dentist
  • Johnson City, TN
  • NPI 1396914990
  NPD (past) Authorized official

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194734335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 PRINCETON RD",
            "address_2": "SUITE A",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376012057",
            "telephone_number": "423-283-4175",
            "fax_number": "423-283-0443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 PRINCETON RD",
            "address_2": "SUITE A",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376012057",
            "telephone_number": "423-283-4175",
            "fax_number": "423-283-0443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH R. KELLY, D.D.S, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT/PRACTIONER",
        "authorized_official_telephone_number": "423-283-4175",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "DS2230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danny Kellum, LPC
• Cynthia Ann Kelly, L.C.S.W.
• Kenneth Raymond Kelly, DDS
• Kristi Karen Kelly, BSW
• Elizabeth Kennedy, BS
• Patrick Ryan Kenney
• Martha M. Kennon, PH.D.
• Linda Elrod Kerley, RPH
• Linda J Kerley, FNP
• Audrey Kessler, RD

• General Practice Dentistry in Johnson City, TN
• Providers in Johnson City, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.