Provider Demographics
NPI:1104442722
Name:DOWNS, KELLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:
Last Name:DOWNS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:11032 BUGGY WHIP DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-3639
Mailing Address - Country:US
Mailing Address - Phone:419-205-6686
Mailing Address - Fax:
Practice Address - Street 1:9857 OLD SAINT AUGUSTINE RD STE 3
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8821
Practice Address - Country:US
Practice Address - Phone:904-853-9068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2023-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN248811223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist