Provider Demographics
NPI:1699769018
Name:KIELY, KEVIN DANIEL (DMD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DANIEL
Last Name:KIELY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:149 OAK HOLW
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-8919
Mailing Address - Country:US
Mailing Address - Phone:757-208-0138
Mailing Address - Fax:757-206-1981
Practice Address - Street 1:5408 DISCOVERY PARK BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2893
Practice Address - Country:US
Practice Address - Phone:757-208-0138
Practice Address - Fax:757-206-1981
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010073031223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery