Provider Demographics
NPI:1043354236
Name:KELLY, ISABEL L (DDS)
Entity type:Individual
Prefix:DR
First Name:ISABEL
Middle Name:L
Last Name:KELLY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449D DOLLEY MADISON BLVD
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3811
Mailing Address - Country:US
Mailing Address - Phone:703-748-3384
Mailing Address - Fax:703-748-3339
Practice Address - Street 1:1449D DOLLEY MADISON BLVD
Practice Address - Street 2:
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3811
Practice Address - Country:US
Practice Address - Phone:703-748-3384
Practice Address - Fax:703-748-3339
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410805122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist