TERRY M. KELLY DMD PA (NPI# 1972640563) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972640563 |
| Entity Type | Organization |
| Organization Name | TERRY M. KELLY DMD PA |
| Practice Address |
12902 Magnolia Drive Head and Neck Clinic Tampa FL 33612 |
| Mailing Address |
701 S Howard Ave Ste 106-307 Tampa FL 33606-2473 |
| Practice Telephone | 8139793968 |
| Practice Fax Number | 8137457464 |
| Mailing Telephone | 8137453968 |
| Mailing Fax Number | 8137457464 |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. TERRY MICHAEL KELLY (OWNER DENTIST) |
| Authorized Official Telephone | 8137453968 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0700X |
Dentist Specialization: Prosthodontics |
DN11407 | FL | Dental Providers |
| Street Address |
12902 MAGNOLIA DRIVE HEAD AND NECK CLINIC |
| City | TAMPA |
| State | FL |
| Zip Code | 33612 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851373088 | Louann Campbell | Nurse Practitioner | 12902 Magnolia Drive, Tampa, FL 33612 | 2005-11-15 |
| 1588110639 | Abdul Rashid Shah | Internal Medicine | 12902 Magnolia Drive, H.lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612 | 2016-08-29 |
| 1700134632 | Nicole Carswell | Dietitian, Registered | 12902 Magnolia Drive, Mod-c Nuther, Tampa, FL 33612 | 2012-08-27 |
| 1962772269 | Gloria Michelle Guess | Nurse Practitioner | 12902 Magnolia Drive, Tampa, FL 33612-9416 | 2012-01-04 |
| 1427285451 | Jason Brayer | Internal Medicine | 12902 Magnolia Drive, Mrc-3e 3045, Tampa, FL 32612 | 2009-06-17 |
| 1790928729 | Jeff S Russell | Internal Medicine | 12902 Magnolia Drive, Moffitt Cancer Center, Tampa, FL 33612 | 2009-04-07 |
| 1386806529 | Salvatore Michael Bottiglieri | Pharmacist | 12902 Magnolia Drive, Moffitt Cancer Center, Dept of Pharmacy, Tampa, FL 33612 | 2008-06-30 |
| 1629264437 | Rikesh Makanji | Radiology | 12902 Magnolia Drive, Tampa, FL 33612 | 2007-09-15 |
| 1285825661 | John Mullinax | Surgery | 12902 Magnolia Drive, Tampa, FL 33612 | 2007-08-09 |
| 1144429317 | Tyler M Neitlich | Radiology | 12902 Magnolia Drive, Tampa, FL 33212 | 2007-07-17 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689286767 | Daniel Jimenez | Physical Therapist | 13000 Bruce B Downs Blvd, Tampa, Fl, Tampa, FL 33612 | 2020-08-19 |
| 1700426830 | Taz Stacy | Behavior Technician | 2701 University Square Drive, Tampa, FL 33612 | 2020-01-07 |
| 1841853215 | Eric Austen Keeler | Student in an Organized Health Care Education/Training Program | 12901 Bruce B Downs Blvd, Mdc5, Tampa, FL 33612 | 2019-04-20 |
| 1346700242 | Caitlyn Victoria Cartwright | Student in an Organized Health Care Education/Training Program | 12901 Bruce B. Downs Blvd., Mdc5, Tampa, FL 33612 | 2019-03-25 |
| 1720552953 | Marijo Bilitski | Student in an Organized Health Care Education/Training Program | 12901 Bruce B Downs Blvd # Blvd5, Tampa, FL 33612 | 2019-01-22 |
| 1790259190 | Belkis Aleman | Nurse Practitioner | 205 E Busch Blvd, Tampa, FL 33612 | 2019-01-18 |
| 1811469133 | Stephanie Stegner | Physician Assistant | 12901 Bruce B Downs Blvd Mdc 5, Tampa, FL 33612 | 2018-12-27 |
| 1053889857 | Alysia Heather Siegel | Psychologist | 1300 Bruce B. Downs Boulevard, 116b, Tampa, FL 33612 | 2018-11-09 |
| 1295202489 | Daisy Baby Pulinilkumkalayil | Nurse Practitioner | 1426 W. Bush Blvd. Suite #105, Suite #105, Tampa, FL 33612 | 2018-10-26 |
| 1649745258 | Rachel Rene Shelton | Specialist/Technologist | Orthopedics and Sports Medicine, 13330 Usf Laurel Drive, Tampa, FL 33612 | 2018-10-10 |
| Find all providers in zip 33612 | ||||
| Taxonomy Code | 1223P0700X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Prosthodontics |
| That branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326650540 | Zineb Mediouni Dmd Pa | Dentist | 14502 N Dale Mabry Hwy Ste 102, Tampa, FL 33618-2076 | 2020-08-19 |
| 1588686463 | Mohammad Reza Iranmanesh | Dentist | 2814 W Waters Ave, Tampa, FL 33614-1853 | 2006-07-23 |
| 1265055628 | Nima Iranmanesh | Dentist | 2814 W Waters Ave, Tampa, FL 33614-1853 | 2020-05-20 |
| 1750588059 | Terry Michael Kelly | Dentist | 10150 Highland Manor Dr, Suite 145, Tampa, FL 33610-9713 | 2007-06-29 |
| 1407947849 | Luis A Alicea | Dentist | 7340 W Waters Ave, Tampa, FL 33634-2222 | 2006-09-28 |
| 1912012261 | Frederick Sanford Muenchinger | Dentist | 3450 E Fletcher Ave, Suite 320, Tampa, FL 33613-4655 | 2006-08-20 |
| 1023083813 | Sterling C. Beasley | Dentist | 13000 Bruce B Downs Blvd, Tampa, FL 33612-4745 | 2006-02-23 |
| 1437124237 | Lori C. Ransohoff | Dentist | 13000 Bruce B Downs Blvd, Tampa, FL 33612-4745 | 2006-02-23 |
| 1801881248 | Barry Craig Ries | Dentist | 8415 Bayshore Blvd, Tampa, FL 33621-1607 | 2005-09-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932728078 | Mohammad Reza Azari Samani | Dentist | 14453 Beach Blvd Ste 100, Jacksonville, FL 32250-2081 | 2020-04-09 |
| 1013562941 | Blanding Dental Associates P.a. | Dentist | 767 Blanding Blvd Ste 108, Orange Park, FL 32065-5788 | 2019-08-07 |
| 1669030037 | Makris Dental LLC | Dentist | 13250 Narcoossee Road, Orlando, FL 32827 | 2019-05-31 |
| 1700365145 | Carlos Soucy Aranguren | Dentist | 1395 Center Dr Rm D9-39d, Gainesville, FL 32610-3006 | 2018-08-07 |
| 1790278448 | Marcela Cardona Echeverri | Dentist | 3872 San Simeon Cir, Weston, FL 33331-5056 | 2018-06-07 |
| 1942704499 | Ngoc Trang Caroline Truong | Dentist | 1395 Center Driveroom D1-19, Gainesville, FL 32610-0001 | 2018-03-20 |
| 1851812515 | Martin Sebastian Lalama | Dentist | 2441 Nw 43rd St Ste 16, Gainesville, FL 32606-6676 | 2017-07-03 |
| 1619497021 | Leila Ahmadian Khoshe Mehr | Dentist | 929 Falling Water Rd, Weston, FL 33326-3555 | 2017-06-27 |
| 1548611510 | Rocio Barocio Torano | Dentist | 2425 Brunello Trce, Lutz, FL 33558-7800 | 2016-06-30 |
| 1659726537 | Alicia Maria Toro | Dentist | 5341 Sw 160th Ave, Southwest Ranches, FL 33331-1410 | 2016-04-28 |
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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.