Provider Demographics
NPI:1437291952
Name:KELLY, ELLEN RAMOS (DMD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:RAMOS
Last Name:KELLY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:905 RIO EAST COURT
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901
Mailing Address - Country:US
Mailing Address - Phone:434-977-4592
Mailing Address - Fax:434-977-0675
Practice Address - Street 1:905 RIO EAST COURT
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901
Practice Address - Country:US
Practice Address - Phone:434-977-4592
Practice Address - Fax:434-977-0675
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010086171223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics