Provider Demographics
NPI:1588098735
Name:KELSEY, ANDREW PATRICK (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:PATRICK
Last Name:KELSEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12222 N CENTRAL EXPY STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3756
Mailing Address - Country:US
Mailing Address - Phone:817-909-6870
Mailing Address - Fax:
Practice Address - Street 1:12222 N CENTRAL EXPY STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3756
Practice Address - Country:US
Practice Address - Phone:817-909-6870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29197122300000X, 1223G0001X, 207K00000X, 207P00000X, 207Q00000X, 207ZF0201X, 207ZP0102X, 2085R0202X, 2085R0205X, 208D00000X, 208U00000X, 208VP0014X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0205XAllopathic & Osteopathic PhysiciansRadiologyRadiological Physics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine