Provider Demographics
NPI:1962745992
Name:KELLEY AND HOLT PLLC
Entity type:Organization
Organization Name:KELLEY AND HOLT PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHELITA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-599-3901
Mailing Address - Street 1:9601 BROOKDALE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-8725
Mailing Address - Country:US
Mailing Address - Phone:704-599-3901
Mailing Address - Fax:
Practice Address - Street 1:9601 BROOKDALE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-8725
Practice Address - Country:US
Practice Address - Phone:704-599-3901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC73111223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty