| Kerry Kelly D.d.s., P.c. | |
|
1025 N. Tioga St. Ithaca NY 14850 | |
| (607) 272-4331 | |
| (607) 240-5618 |
| Full Name | Kerry Kelly D.d.s., P.c. |
|---|---|
| Speciality | Dentist |
| Location | 1025 N. Tioga St., Ithaca, New York |
| Authorized Official Name and Position | Kerry Lyn Kelly (OWNER/DENTIST) |
| Authorized Official Contact | 6072724331 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kerry Kelly D.d.s., P.c. 1025 N. Tioga St. Ithaca NY 14850 Ph: (607) 272-4331 | Kerry Kelly D.d.s., P.c. 1025 N. Tioga St. Ithaca NY 14850 Ph: (607) 272-4331 |
| NPI Number | 1700355849 |
|---|---|
| Provider Enumeration Date | 11/19/2018 |
| Last Update Date | 11/19/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700355849 | NPI | - | NPPES |
| 02050572 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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