Kelly Susan Kennan, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12599 Issued in MD

Practice address

1322 Belmont Ave Suite 204
Salisbury, MD 21804

Phone

(410) 742-4339

Fax

(410) 742-4388

NPI assigned

Jun 14, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

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

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555545600000",
    "number": "1295778454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1322 BELMONT AVE SUITE 204",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "21804",
            "telephone_number": "410-742-4339",
            "fax_number": "410-742-4388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1322 BELMONT AVE SUITE 204",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "21804",
            "telephone_number": "410-742-4339",
            "fax_number": "410-742-4388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNAN",
        "first_name": "KELLY",
        "middle_name": "SUSAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-14",
        "last_updated": "2019-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "12599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia A Kelly, CRNA
• Detra Kelly, LCSW-C
• Shannon Elizabeth Kelly, OTR/L
• Thomas E Kelly, M.D.
• Sintayehu Kenea
• Lee Ann Kenney-Shoup, LCPC
• Catherine Ann Kenney, PSYCHOLOGY ASSOCIATE
• Jill Allison Kenney
• Carter Ethan Kenton
• Kim Ann Keosian, ANP

• General Practice Dentistry in Salisbury, MD
• Providers in Salisbury, MD by specialty
• General Practice Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2019; 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.