Provider Demographics
NPI:1306463344
Name:JOSEPH, KELLY ISABEL (DMD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ISABEL
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ISABEL
Other - Last Name:CALDERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:13931 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-3002
Mailing Address - Country:US
Mailing Address - Phone:954-591-4675
Mailing Address - Fax:
Practice Address - Street 1:13931 OAK RIDGE DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33325-3002
Practice Address - Country:US
Practice Address - Phone:954-591-4675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-25
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24891122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist