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Provider Information for 1992888242

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. ANDREW WAYNE KELLY DDS

Gender: MALE

Individual NPI: 1992888242

Calendar   Last Updated:  2018-12-27
  Certification Date: 

Details

Name Value
NPI 1992888242
Enumeration Date 2006-10-23
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 137 N HIDDENBROOKE DR
ADVANCE, NC 27006-7299
United States

Phone: 336-766-7966 | Fax: 336-940-5346
View Map External Link
Primary Practice Address 5710 W GATE CITY BLVD
GREENSBORO, NC 27407-7061
United States

Phone: 336-766-7966 | Fax: 877-840-4367
View Map External Link
Secondary Practice Address 1241 W CLEMMONSVILLE RD
WINSTON SALEM, NC 27127-4790
United States

Phone: 336-766-7966 | Fax: 877-840-4367
View Map External Link

Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Other IRS 82-3139362
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice NC 7350
No 1223G0001X - Dentist General Practice CA 35919