Edward T Kelly Iv, DMD in Hartford, CT - Medicare Dentist Provider

Edward T Kelly Iv, DMD is a medicare enrolled "Dentist - General Practice" provider in Hartford, Connecticut. His current practice location is 114 Woodland St, Hartford, Connecticut. You can reach out to his office (for appointments etc.) via phone at (860) 714-4995.

Edward T Kelly Iv is licensed to practice in Connecticut (license number 010536) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1124315957.

Contact Information

	Edward T Kelly Iv, DMD
	114 Woodland St, Hartford, CT 06105-1208
	(860) 714-4995
	(860) 714-8005

Healthcare Provider's Profile

Full Name	Edward T Kelly Iv
Gender	Male
Speciality	Dentist - General Practice
Location	114 Woodland St, Hartford, Connecticut
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1124315957
Provider Enumeration Date: 06/30/2011
Last Update Date: 08/23/2013

Medicare PECOS Information:

PECOS PAC ID: 6305159484
Enrollment ID: I20150717002403

Medical Identifiers

Medical identifiers for Edward T Kelly Iv such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1124315957	NPI	-	NPPES
004011201	Medicaid	CT

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
1223G0001X	Dentist - General Practice	010536 (Connecticut)	Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Edward T Kelly Iv is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Edward T Kelly Iv, DMD 114 Woodland St, Hartford, CT 06105-1208 Ph: (860) 714-4529	Edward T Kelly Iv, DMD 114 Woodland St, Hartford, CT 06105-1208 Ph: (860) 714-4995

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Edward T Kelly Iv, DMD - Medicare Dentist in Hartford, CT