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Dr. John R Kelly, DDS
Pediatric Dentist in Port Matilda, Pennsylvania
NPI 1861615569

John R Kelly is a Pediatric Dentist based in Port Matilda, PA and is specialized in Pediatric Dentistry. John R Kelly practices in Port Matilda, PA and has the professional credentials of DDS. The NPI Number for John R Kelly is 1861615569 and holds a License No. DS-019843-L (Pennsylvania).

The current practice location address for John R Kelly is 1019 Ghaner Rd Ste A, Port Matilda, PA and can be reached out via phone at 814-238-7120 and via fax at 814-238-2981.

Location: 1019 Ghaner Rd Ste A, Port Matilda, PA, 16870-7201
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1861615569
Provider Name
John R Kelly
Credential
DDS
Provider Entity Type
Individual
Gender
Male
Address
1019 Ghaner Rd Ste A, Port Matilda, PA, 16870-7201
Phone Number
814-238-7120
Fax Number
814-238-2981
Provider Enumeration Date
04/11/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
0005104610001 05 PA
institution
Provider Business Practice Location Address Details
Address
1019 Ghaner Rd Ste A
City
Port Matilda
State
Pennsylvania
Zip
16870-7201
Phone Number
814-238-7120
Fax Number
814-238-2981
person
Provider Business Mailing Address Details
Address
1019 Ghaner Rd Ste A
City
Port Matilda
State
Pennsylvania
Zip
16870-7201
Phone Number
814-238-7120
Fax Number
814-238-2981
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Pediatric Dentistry
Taxonomy
1223P0221X
License No.
DS-019843-L (Pennsylvania)
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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