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

Active since July 14, 2023
455 LAKESHORE PARKWAY, ROCK HILL, SC 29730(803) 909-6363 Get Directions Write a Review

NPPES record last updated: March 31, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 31, 2025, Mar 27, 2025, Jul 14, 2023 (3 updates tracked since 2023).

About Dr. Khadijah Kelly Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KHADIJAH KELLY DDS (NPI 1730868902) is an individual general practice provider in Rock Hill, South Carolina, licensed in South Carolina (10961) and active in the NPI registry since July 2023.

NPPES Registry Identity

NPI1730868902
Entity TypeIndividualFemale
Primary Taxonomy1223G0001X
Provider Legal NameDR. KHADIJAH KELLYCredential: DDS
Location Address455 LAKESHORE PARKWAYRock Hill, SC 29730-4205
Mailing Address2043 Morton StCharlotte, NC 28208-5564 · (678) 913-8276
Phone(803) 909-6363
Sole ProprietorNo
Enumeration DateJuly 14, 2023
Last NPPES UpdateMarch 31, 20253 updates tracked since enumeration
NPPES CertifiedMay 1, 2023
✔ NPI 1730868902 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in SC · 10961
Definition
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.
455 LAKESHORE PARKWAY, Rock Hill, SC 29730
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Other Identifiers 1

MedicaidZX0962SC

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter of North Carolina, Anthem Blue Cross and Blue Shield and more.Insurance ›

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CHIKA AGNES AKAMNONU DDS
Dentist
455 LAKESHORE PARKWAY
ROCK HILL, SC 29730
York County (803) 909-6363
PATRICIA KIRKLEY JONES DNP-FNP-BC
Nurse Practitioner (Family)
455 LAKESHORE PARKWAY
ROCK HILL, SC 29730
York County (803) 909-6363

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Khadijah Kelly's NPI number?

The NPI number for Khadijah Kelly is 1730868902. It was assigned to this individual provider in the NPPES registry on July 14, 2023.

Where is Khadijah Kelly located?

Khadijah Kelly practices at 455 Lakeshore Parkway, Rock Hill, SC 29730. The listed phone number is (803) 909-6363.

What is Khadijah Kelly's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

What insurance does Khadijah Kelly accept?

Health plans from Ambetter from Absolute Total Care, Ambetter of North Carolina, Anthem Blue Cross and Blue Shield, BEST Life and Blue Cross and Blue Shield of Montana and 10 other insurers list Khadijah Kelly as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Khadijah Kelly was last updated on March 31, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.