NPIMap

Organization Active NPI

A W Kelly DDS PLLC

Doing business as Dental Center of the Carolinas

  • General Practice Dentistry
  • Winston Salem, NC
National Provider Identifier
1932611092
Registry record updated Aug 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
07350 Issued in NC
Legal business name
A W KELLY DDS PLLC
Doing business as
Dental Center of the Carolinas
Practice address
4550 Country Club Rd
Winston Salem, NC 27104-3518
Phone
(333) 766-7966
Fax
(877) 840-4367
NPI assigned
Oct 30, 2017
Last updated
Aug 14, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2023

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

Authorized official

Name
Dr. Andrew Wayne Kelly, DDSNPI 1992888242
Title
Owner/ Manager
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
General Practice Dentistry 1223G0001X 07350 NC Primary

Addresses

Primary practice location

4550 Country Club Rd
Winston Salem, NC 27104-3518

Mailing address

137 N Hiddenbrooke Dr
Advance, NC 27006-7299
Phone (336) 766-7966

Other practice location 1

5509B W Friendly Ave Ste 200
Greensboro, NC 27410-4279
Phone (336) 500-0422

Other identifiers 1

IdentifierTypeStateIssuer
1992888242MedicaidNC

Other names 1

  • Dental Center of the Carolinas Doing business as

National Provider Directory

National Provider Directory

Locations

5509B W Friendly Ave
Ste 200
Greensboro, NC 27410
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": "1509321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691971200000",
    "number": "1932611092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "137 N HIDDENBROOKE DR",
            "city": "ADVANCE",
            "state": "NC",
            "postal_code": "270067299",
            "telephone_number": "336-766-7966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4550 COUNTRY CLUB RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271043518",
            "telephone_number": "333-766-7966",
            "fax_number": "877-840-4367"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5509B W Friendly Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274104279",
            "country_code": "US",
            "telephone_number": "336-500-0422",
            "fax_number": "336-294-0735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "A W KELLY DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-30",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "OWNER/ MANAGER",
        "authorized_official_telephone_number": "336-766-7966",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "07350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992888242",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental Center of the Carolinas",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dental Center of the Carolinas",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; 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.