Kerry Lyn Kelly, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

058846 Issued in NY

Practice address

6692 Middle Rd
Suite 2100
Sodus, NY 14551-9602

Phone

(315) 483-1199

Fax

(315) 483-2451

NPI assigned

May 13, 2015

Last updated

Oct 13, 2016By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Finger Lakes Community Health

  dba Dundee Community Health

  • Federally Qualified Health Center (FQHC)
  • Dundee, NY
  • NPI 1366939878
  NPD (past)
• Finger Lakes Community Health

  • Federally Qualified Health Center (FQHC)
  • Sodus, NY
  • NPI 1669568465
  NPD (past)

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

{
    "created_epoch": "1431475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476316800000",
    "number": "1306224142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 MAIDEN LN",
            "address_2": "PO BOX 423",
            "city": "PENN YAN",
            "state": "NY",
            "postal_code": "145271208",
            "telephone_number": "315-531-9102",
            "fax_number": "315-531-9103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6692 MIDDLE RD",
            "address_2": "SUITE 2100",
            "city": "SODUS",
            "state": "NY",
            "postal_code": "145519602",
            "telephone_number": "315-483-1199",
            "fax_number": "315-483-2451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KERRY",
        "middle_name": "LYN",
        "name_prefix": "Miss",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-13",
        "last_updated": "2016-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "058846",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "058846",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marissa Marie Holloway, LMSW
• Michelle Jason
• Paula Jock, LPN
• Wendy Sue Johnson, PHARMD.
• Joseph Michael Keeney, SLP
• Niloal M Kijowski, LPN
• Weleed Langer, OD
• Christopher Lehfeldt, D.D.S.
• Dawn Marie Leone, OTR/L
• Heather Lobrutto, PNP

• General Practice Dentistry in Sodus, NY
• Providers in Sodus, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2016; 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.