Provider Demographics
NPI:1588158299
Name:BARBERA, KELLY ANN (DMD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANN
Last Name:BARBERA
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 1:1154 OLD COACH XING
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-1538
Mailing Address - Country:US
Mailing Address - Phone:845-416-7601
Mailing Address - Fax:
Practice Address - Street 1:53 SOUTHAMPTON RD STE 6
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-1382
Practice Address - Country:US
Practice Address - Phone:413-562-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-16
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18580441223E0200X, 1223G0001X
MEDEN47861223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty