MARIE PETTERS KELLY (NPI# 1114417045) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114417045 |
| Entity Type | Organization |
| Organization Name | MARIE PETTERS KELLY |
| Practice Address |
1670 Lincoln Hwy E Lancaster PA 17602-2663 |
| Practice Telephone | 7173941067 |
| Mailing Telephone | 7173941067 |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2018-05-16 |
| Authorized Official Name | DANIEL KELLY (GM) |
| Authorized Official Telephone | 7179254327 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QD0000X |
Clinic/Center Specialization: Dental |
DS035577 | PA | Ambulatory Health Care Facilities |
| N | 261QD0000X |
Clinic/Center Specialization: Dental |
DS040000 | PA | Ambulatory Health Care Facilities |
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
DS025788L | PA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | DENTAL LICENSE | DS025788L | 01 |
| PA | DENTAL LICENSE | DS040000 | 01 |
| PA | DENTAL LICENSE | DS035577 | 01 |
| Street Address |
1670 LINCOLN HWY E |
| City | LANCASTER |
| State | PA |
| Zip Code | 17602-2663 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093826323 | Marie Petters Kelly | Dentist | 1670 Lincoln Hwy E, Lancaster, PA 17602-2663 | 2006-08-31 |
| 1386080893 | Peter William Innacola | Dentist | 1670 Lincoln Hwy E, Carano Dental Grp, Lancaster, PA 17602-2663 | 2013-05-13 |
| 1467695171 | Anne Stuccio | Dentist | 1670 Lincoln Hwy E, Lancaster, PA 17602-2663 | 2009-04-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093313173 | Taylor Giambrone | Registered Nurse | Lgh Nurse Family Partnership, 555 North Duke Street, Lancaster, PA 17602 | 2020-10-12 |
| 1982268843 | Blanche Nichole Breznak | Pharmacist | 201 East Chestnut St, Lancaster, PA 17602 | 2019-04-25 |
| 1285104851 | Stephanie Benedict | Pharmacist | 1603 Lincoln Highway East, Lancaster, PA 17602 | 2018-11-27 |
| 1043709835 | Deborah J Campos-bard, Lmt | Massage Therapist | 439 N. Duke St. 2nd Fl., 2, Lancaster, PA 17602 | 2018-05-07 |
| 1861989493 | Functional Freedom LLC | Occupational Therapist | 105 Heritage Rd., Lancaster, PA 17602 | 2018-04-19 |
| 1083094577 | Gracie Berry | Counselor | 413 Church St, Lancaster, PA 17602 | 2015-06-01 |
| 1366835597 | Holcomb Associates, Inc. | Community/Behavioral Health | 800 New Holland Avenue, Lancaster, PA 17602 | 2015-03-12 |
| 1205236965 | Maria Taylor | Physician Assistant | 555 N Duke Street, Lghp Hospitalists, Lancaster, PA 17602 | 2014-09-01 |
| 1114355104 | Charles Eugene Stream | Physician Assistant | 133 East Fredeick Street, Lancaster, PA 17602 | 2013-10-29 |
| 1710221668 | Kourtney Randsdorp | Occupational Therapist | 105 Heritage Rd, Lancaster, PA 17602 | 2012-11-15 |
| Find all providers in zip 17602 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225645633 | Lancaster Advanced Dental Inc. | Clinic/Center | 1745 W Avenue K Ste C, Lancaster, CA 93534-6504 | 2020-09-29 |
| 1730799156 | Royal Family Dentistry Pllc | Clinic/Center | 525 W Pleasant Run Rd Ste 200, Lancaster, TX 75146-1576 | 2020-08-01 |
| 1861032401 | Neil R Sangani Dds Inc | Clinic/Center | 44820 10th St W # 101, Lancaster, CA 93534-2312 | 2020-01-12 |
| 1548761182 | Av Dental Wellness Group | Clinic/Center | 151 E Avenue J Ste A, Lancaster, CA 93535-3520 | 2018-02-27 |
| 1902344039 | Smile Arc Orthodontics & Pedodontics LLC | Clinic/Center | 2211 Erin Ct, Lancaster, PA 17601-1960 | 2017-02-09 |
| 1295048023 | Kevin Ju, Dds, Inc. | Clinic/Center | 44439 17th St W Ste 201, 201, Lancaster, CA 93534-2856 | 2010-07-21 |
| 1235441742 | Water Street Health Services | Clinic/Center | 210 S Prince St, Lancaster, PA 17603-5314 | 2010-07-13 |
| 1336348390 | Dental Professionals of South Carolina, P.C. | Clinic/Center | 1025 W. Meeting St, Suite 100, Lancaster, SC 29720 | 2007-07-11 |
| 1558564385 | Family Dynamics LLC | Clinic/Center | 1183 Stanford Rd., Lancaster, KY 40444-9567 | 2007-06-08 |
| 1568083392 | William L Medved Dds Family Dentistry,inc | Clinic/Center | 330 N Broad St, Lancaster, OH 43130-3003 | 2020-05-04 |
| Find all providers in LANCASTER | ||||
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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.