Provider Demographics
NPI:1588693931
Name:KELLY, JOHN HENRY (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HENRY
Last Name:KELLY
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 1:853 WESTPOINT PKWY
Mailing Address - Street 2:SUITE 740
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1532
Mailing Address - Country:US
Mailing Address - Phone:440-871-9944
Mailing Address - Fax:440-871-9384
Practice Address - Street 1:853 WESTPOINT PKWY
Practice Address - Street 2:SUITE 740
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1532
Practice Address - Country:US
Practice Address - Phone:440-871-9944
Practice Address - Fax:440-871-9384
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH148441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice