Provider Demographics
NPI:1962425215
Name:KELLEY, WILLIAM M (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:M
Last Name:KELLEY
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 1:780 E ROMIE LN STE F
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4223
Mailing Address - Country:US
Mailing Address - Phone:831-422-5832
Mailing Address - Fax:
Practice Address - Street 1:780 E ROMIE LN STE F
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4223
Practice Address - Country:US
Practice Address - Phone:831-422-5832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice