DR. KHADIJAH KELLY DDS
NPI 1730868902
Dentist - General Practice in Rock Hill, SC

NPI Status: Active since July 14, 2023

Contact Information

455 LAKESHORE PARKWAY
ROCK HILL, SC
ZIP 29730
Phone: (803) 909-6363

NPI Profile Information
Primary Taxonomy
Insurance Plans Accepted
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Female
Dentist
General Practice

About KHADIJAH KELLY

This page provides the complete NPI Profile along with additional information for Khadijah Kelly, a provider established in Rock Hill, South Carolina with a medical specialization in Dentist, focusing in general practice . The healthcare provider is registered in the NPI registry with number 1730868902 assigned on July 2023. The practitioner's primary taxonomy code is 1223G0001X with license number 10961 (SC). The provider is registered as an individual and her NPI record was last updated March 2025.

NPI: 1730868902
Provider Name: DR. KHADIJAH KELLY DDS
Gender: Female
Entity Type: Individual
Location Address: 455 LAKESHORE PARKWAY ROCK HILL, SC 29730
Location Phone: (803) 909-6363
Mailing Address: 2043 MORTON ST CHARLOTTE, NC 28208
Mailing Phone: (678) 913-8276
Is Sole Proprietor?: No
Enumeration Date: 07-14-2023
Last Update Date: 03-31-2025
Code Navigator

A dentist like Khadijah Kelly is a skilled in and licensed provider that diagnoses and treats problems with patients teeth, gums, and related parts of the mouth. Dentists educate patients on how to take care of the teeth and gums and provide information on diet choices that affect oral health. Dentists must be licensed in the state in which they work.

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Dentist General Practice
Taxonomy Code: 1223G0001X
Type: Dental Providers
License No.: 10961
License State: SC
Taxonomy Description: A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier	Type / Code	Identifier State	Identifier Issuer
ZX0962	MEDICAID (05)	SC

NPI Validation Check Digit Calculation

The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1	7	3	0	8	6	8	9	0	2
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2	7	6	0	16	6	16	9	0
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 7 + 6 + 0 + 1 + 6 + 6 + 1 + 6 + 9 + 0 + 24 = 68
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
70 - 68 = 2									2

The NPI number 1730868902 is valid because the calculated check digit 2 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location

The following 5 providers are registered at the same or nearby location.

STEPHANIE M NEAL FNP

Nurse Practitioner

(Family)