Khadijah Kelly, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10961 Issued in SC

Practice address

455 Lakeshore Parkway
Rock Hill, SC 29730-4205

Phone

(803) 909-6363

NPI assigned

Jul 14, 2023

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 and National Provider Directory roles.

• Affinity Health Center

  dba Affinity Health Center- Dental

  • General Practice Dentistry
  • Rock Hill, SC
  • NPI 1932690989
  NPD (past)

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

{
    "created_epoch": "1689292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743379200000",
    "number": "1730868902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2043 MORTON ST",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282085564",
            "telephone_number": "678-913-8276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 LAKESHORE PARKWAY",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297304205",
            "telephone_number": "803-909-6363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KHADIJAH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-14",
        "last_updated": "2025-03-31",
        "certification_date": "2023-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "10961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX0962",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Farrah Elizabeth Keitt, LPN
• Terri Keller, PHARMD
• Mary Campbell Kellett
• Franklin Mi'Kael Kelly, DC
• Jeremy A Kelly
• Marie Michelle Kelly, MCD CCC-SLP
• Marsha D Kelly, C.N.M.
• Michaela Mary Kelly, LMHC, LPC
• Timothy J Kelly, M.D.
• Wendy Kemmer, FNP

• General Practice Dentistry in Rock Hill, SC
• Providers in Rock Hill, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2025; 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.