Provider Demographics
NPI:1558828475
Name:BINDING, KELLY (DMD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BINDING
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PECKOSH PEDIATRIC DENTISTRY
Mailing Address - Street 2:3455 STONEMAN ROAD SUITE 2B
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-5269
Mailing Address - Country:US
Mailing Address - Phone:563-582-1478
Mailing Address - Fax:
Practice Address - Street 1:3455 STONEMAN RD STE 2B
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-5269
Practice Address - Country:US
Practice Address - Phone:563-582-1478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA30557390200000X
IADDS-098861223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program