Andrew Wayne Kelly, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7350 Issued in NC

Practice address

5509B W Friendly Ave Ste 200
Greensboro, NC 27410-4279

Phone

(336) 766-7966

Fax

(877) 840-4367

NPI assigned

Oct 23, 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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1992888242",
    "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",
            "fax_number": "336-940-5346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5509B W FRIENDLY AVE STE 200",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274104279",
            "telephone_number": "336-766-7966",
            "fax_number": "877-840-4367"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4550 Country Club Rd",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271043518",
            "country_code": "US",
            "telephone_number": "336-766-7966",
            "fax_number": "877-840-4367",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "ANDREW",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "35919",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "7350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1932611092",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IRS",
            "identifier": "82-3139362",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Suzanne Marie Kelley, COTA
• Kellin Foundation
• Kellin Foundation
• Kellin, PLLC
• Douglas Alan Kellogg, D.D.S.
• Chenay A Kelly
• Elizabeth Kelly
• Hailey Seaver Kelly, PHARMD
• Krystle Kelly, NP
• Melissa D Kelly, CPNP

• General Practice Dentistry in Greensboro, NC
• Providers in Greensboro, NC by specialty
• General Practice Dentistry in North Carolina

• 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.