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Diane C Kelly Dmd, Pc
Pediatric Dentist in Gainesville, Georgia
NPI 1740452465

Diane C Kelly Dmd, Pc is a Pediatric Dentist based in Gainesville, GA and is specialized in Pediatric Dentistry. Diane C Kelly Dmd, Pc practices in Gainesville, GA. The NPI Number for Diane C Kelly Dmd, Pc is 1740452465 and holds a License No. DNO12082 (Georgia).

The current practice location address for Diane C Kelly Dmd, Pc is 655 Jesse Jewell Pkwy Se, Gainesville, GA and can be reached out via phone at 770-539-9110 and via fax at 678-714-8388.

Location: 655 Jesse Jewell Pkwy Se, Gainesville, GA, 30501
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1740452465
Provider Name
Diane C Kelly Dmd, Pc
Credential
Provider Entity Type
Organization
Address
655 Jesse Jewell Pkwy Se, Gainesville, GA, 30501
Phone Number
770-539-9110
Fax Number
678-714-8388
Provider Enumeration Date
04/02/2008
Last Update Date
02/15/2025
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Provider's Legacy Identifiers
Identifier Type State Issuer
186794814A 05 GA
191450941A 05 GA
390489607J 05 GA
000046582Y 05 GA
919057925B 05 GA
514725717B 05 GA
000851727B 05 GA
609963109E 05 GA
218323780A 05 GA
609963109L 05 GA
institution
Provider Business Practice Location Address Details
Address
655 Jesse Jewell Pkwy Se
City
Gainesville
State
Georgia
Zip
30501
Phone Number
770-539-9110
Fax Number
678-714-8388
person
Provider Business Mailing Address Details
Address
655 Jesse Jewell Pkwy Se
City
Gainesville
State
Georgia
Zip
30501
Phone Number
770-539-9110
Fax Number
678-714-8388
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Pediatric Dentistry
Taxonomy
1223P0221X
License No.
DNO12082 (Georgia)
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
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