NPIMap

Organization Active NPI

Andrew W Kelly DDS PLLC

Doing business as Dental Center of the Carolinas

  • Dental Clinic/Center
  • Clemmons, NC
National Provider Identifier
1700203247
Registry record updated Mar 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
7350 Issued in NC
Legal business name
ANDREW W KELLY DDS PLLC
Doing business as
Dental Center of the Carolinas
Practice address
4164 Clemmons Rd
Clemmons, NC 27012-7520
Phone
(336) 766-7966
NPI assigned
Mar 22, 2014
Last updated
Mar 22, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2014

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

Authorized official

Name
Andrew Wayne Kelly, DDSNPI 1992888242
Title
Manager/Dentist
Phone
(336) 766-7966

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 7350 NC Primary

Addresses

Primary practice location

4164 Clemmons Rd
Clemmons, NC 27012-7520

Mailing address

4164 Clemmons Rd
Clemmons, NC 27012-7520
Phone (336) 766-7966

Other names 1

  • Dental Center of the Carolinas Doing business as

National Provider Directory

National Provider Directory

Locations

4164 Clemmons Rd
Clemmons, NC 27012
Phone (336) 766-7966

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1395446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395446400000",
    "number": "1700203247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4164 CLEMMONS RD",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270127520",
            "telephone_number": "336-766-7966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4164 CLEMMONS RD",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270127520",
            "telephone_number": "336-766-7966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDREW W KELLY DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-22",
        "last_updated": "2014-03-22",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "MANAGER/DENTIST",
        "authorized_official_telephone_number": "336-766-7966",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NC",
            "license": "7350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental Center of the Carolinas",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clemmons, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2014; 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.