EDWARD T KELLY IV (NPI# 1124315957) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124315957 |
| Entity Type | Individual |
| Full Name | EDWARD T KELLY IV |
| Credential | DMD |
| Practice Address |
114 Woodland St Hartford CT 06105-1208 |
| Practice Telephone | 8607144995 |
| Practice Fax Number | 8607148005 |
| Mailing Telephone | 8607144529 |
| Mailing Fax Number | 8607148003 |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2013-08-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
010536 | CT | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 004011201 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417289927 | Edward Allen Kelly | General Practice | 315 Hillsboro St, Pittsboro, NC 27312-9313 | 2010-02-08 |
| 1164616488 | Edward M Kelly Jr. | Dentist | 1726 W Jarrettsville Rd, Jarrettsville, MD 21804-1524 | 2007-08-29 |
| 1235122300 | Edward A. Kelly Jr. | Family Medicine | 99 Manor Ave, Downingtown, PA 19335-2620 | 2005-08-24 |
| 1891344024 | Edward Robert Kelly | Specialist/Technologist | 512 N Campus, Ithaca, NY 14853-6007 | 2019-09-10 |
| 1679134910 | Edward Joseph Kelly Iv | Surgery | Musc Gme Office 169 Ashley Avenue Room 202 Muh Msc 33, Charleston, SC 29425-0001 | 2019-06-26 |
| 1326450073 | Edward M Kelly | Physical Therapy Assistant | 11039 Dugway Rd, Fillmore, NY 14735-8610 | 2014-05-29 |
| 1699015610 | Edward George Kelly | Orthopaedic Surgery | 212 9th St, Pittsburgh, PA 15222-3517 | 2013-02-28 |
| 1083890503 | Edward Lawrence Kelly Jr. | Licensed Practical Nurse | 711 S Vine St, Glenwood, IA 51534-1927 | 2008-01-15 |
| 1609929074 | Edward James Kelly | Chiropractor | 231 W Patison St, Port Hadlock, WA 98339-9751 | 2007-01-19 |
| 1235146689 | Edward Kelly | Dentist | 5900 Spout Springs Rd, Ste U-21, Flowery Branch, GA 30542-6448 | 2006-08-01 |
| Street Address |
114 WOODLAND ST |
| City | HARTFORD |
| State | CT |
| Zip Code | 06105-1208 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255334207 | Richard Soucier | Internal Medicine | 114 Woodland St, Hartford, CT 06105-1208 | 2005-05-23 |
| 1003425745 | Brooke M P Chaves | Nurse Practitioner | 114 Woodland St, Hartford, CT 06105-1208 | 2020-07-29 |
| 1215545793 | Xuanthao Nguyen | Nurse Practitioner | 114 Woodland St, Hartford, CT 06105-1208 | 2020-07-21 |
| 1053939231 | Daniel Guilmette | Nurse Anesthetist, Certified Registered | 114 Woodland St, Hartford, CT 06105-1208 | 2020-07-14 |
| 1598383556 | Sarah Beth Flynn-savoie | Nurse Practitioner | 114 Woodland St, Hartford, CT 06105-1208 | 2020-07-07 |
| 1215550215 | Rachael Barber | Speech-Language Pathologist | 114 Woodland St, Hartford, CT 06105-1208 | 2020-05-26 |
| 1407479595 | Erin Michelle Sullivan | Physician Assistant | 114 Woodland St, Hartford, CT 06105-1208 | 2020-05-22 |
| 1831712256 | Hospitalist Medicine Physicians of Connecticut - Tcs, LLC | Family Medicine | 114 Woodland St, Hartford, CT 06105-1208 | 2020-05-20 |
| 1164044947 | Marena Josephine Harrison | Physician Assistant | 114 Woodland St, Hartford, CT 06105-1208 | 2020-05-14 |
| 1477175776 | David Neubauer | Physician Assistant | 114 Woodland St, Hartford, CT 06105-1208 | 2020-05-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275155939 | Pruthwy R Addanki | Student in an Organized Health Care Education/Training Program | Saint Francis Clinic, 1000 Asylum Avenue, Suite 1004, Hartford, CT 06105 | 2020-05-15 |
| 1700447802 | Samuel Flynn | Student in an Organized Health Care Education/Training Program | 1000 Asylum Avenue, Suite 3200, Hartford, CT 06105 | 2019-06-28 |
| 1730743568 | Turab J Mohammed | Student in an Organized Health Care Education/Training Program | Saint Francis Hospital Clinic, 1000 Asylum Avenue, Suite 1004, Hartford, CT 06105 | 2019-04-26 |
| 1164900387 | Breanne Ferrara | Social Worker | 43 Wooland St, Hartford, CT 06105 | 2018-07-31 |
| 1154814069 | Signature Smiles of Hartford LLC | Dentist | 550 Farmington Avenue, Suite B, Hartford, CT 06105 | 2018-06-14 |
| 1356839062 | Jaimy Villavicencio | Student in an Organized Health Care Education/Training Program | 100 Asylum Avenue, Suite 1004, Hartford, CT 06105 | 2018-04-27 |
| 1750885679 | Brittany Bird | Student in an Organized Health Care Education/Training Program | 839-841 Asylum Avenue, Hartford, CT 06105 | 2018-03-23 |
| 1972032241 | Ashley Nicole Mills | Student in an Organized Health Care Education/Training Program | 896 Asylum Ave, 3rd Floor, Hartford, CT 06105 | 2017-06-08 |
| 1528506847 | Samuel Agyei | Social Worker | 291 Collins St, Hartford, CT 06105 | 2017-02-07 |
| 1841735818 | Katie Strahowski | Nurse Practitioner | 85 Gillett Street, Clean Slate, Hartford, CT 06105 | 2016-12-30 |
| Find all providers in zip 06105 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295374296 | The Smile Studio At Bushnell Park | Dentist | 1 Gold St Ste Q, Hartford, CT 06103-2914 | 2019-12-23 |
| 1013417112 | Nicholas Oliveri | Dentist | 37 Airport Rd, Hartford, CT 06114-2002 | 2018-02-15 |
| 1295242238 | Family Dentistry of Hartford Pllc | Dentist | 19 Woodland St Ste 25, Hartford, CT 06105-2335 | 2017-12-29 |
| 1154847044 | Na Won Lee | Dentist | 191 Franklin Ave., Care Dental Center, Hartford, CT 06114 | 2017-08-22 |
| 1588005243 | Tooth & Gums Dentistry | Dentist | 1500 Albany Ave, Hartford, CT 06112-2113 | 2013-07-10 |
| 1083955348 | K & L Dental LLC | Dentist | 629 Albany Ave, Hartford, CT 06112-2334 | 2013-03-12 |
| 1518234079 | Park Street Family Dental | Dentist | 454 Park St, Hartford, CT 06106-1525 | 2011-11-28 |
| 1023325255 | Janyn Khresty Baird | Dentist | 550 Farmington Ave, Hartford, CT 06105-3049 | 2010-09-09 |
| 1407006133 | Mang Chou Shu | Dentist | 1 Financial Plz Fl 19, Hartford, CT 06103-2608 | 2008-09-30 |
| 1841454725 | Loay Hammad | Dentist | 31 William Shorty Campbell St, Hartford, CT 06106-3401 | 2008-07-10 |
| Find all providers in HARTFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.