Provider Demographics
NPI:1144614306
Name:KELLY, JENNIFER ANNE (RDH)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANNE
Last Name:KELLY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:60 EXETER RD SUITE 105
Mailing Address - Street 2:BUILDING 100 NEWMARKET DENTAL
Mailing Address - City:NEW MARKET
Mailing Address - State:NH
Mailing Address - Zip Code:03857
Mailing Address - Country:US
Mailing Address - Phone:603-659-3392
Mailing Address - Fax:603-659-7263
Practice Address - Street 1:60 EXETER RD
Practice Address - Street 2:SUITE 105 BUILDING 100
Practice Address - City:NEW MARKET
Practice Address - State:NH
Practice Address - Zip Code:03857
Practice Address - Country:US
Practice Address - Phone:603-659-3392
Practice Address - Fax:603-659-7263
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02570124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist