Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 5546 | CT |
NPI | 1013977008 |
---|---|
Provider Name | Dr. Thomas Francis Kelly |
First Address | Fairfield, CA 94534 |
Second Address | Travis Afb, CA 94535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 08/07/2007 |