Terence Patrick Kelly, D.D.S.

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

57.246804 Issued in OH

Practice address

500 Gypsy LN
Youngstown, OH 44504

Phone

(330) 884-1000

NPI assigned

Dec 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530230400000",
    "number": "1508927757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7649 EARLINGTON PKWY",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430173424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 GYPSY LN",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "44504",
            "telephone_number": "330-884-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1221 Hayes Ave",
            "address_2": "Suite C",
            "address_purpose": "LOCATION",
            "city": "Sandusky",
            "state": "OH",
            "postal_code": "448703345",
            "country_code": "US",
            "telephone_number": "419-627-8131",
            "fax_number": "419-621-1773",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "TERENCE",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2018-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OH",
            "license": "30-017132",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": "57.246804",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2073232",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cortnee Janae Kelly, ACNP
• Deveeta R Kelly
• Lorraine Kelly, MS, LPCC-S
• Louis Kelly
• Sharon Kelly
• Jessica Leigh Keltenbaugh
• Sarah S Kelty
• Alberta S Kemper, PNP-BC
• Kencare Education Training Center Inc
• Kimberly J. Kengor, MS, RD, CDE

• Student in an Organized Health Care Education/Training Program in Youngstown, OH
• Providers in Youngstown, OH by specialty
• Student in an Organized Health Care Education/Training Program in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 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.