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Organization
KELNERPERIOLLC
Active
Organization
KELNERPERIOLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD MICHAEL KELNER DMD (PARTNER OWNER)
(732) 587-6740
Entity
Organization
Contact information
Practice address
67 WALNUT AVE STE 307, CLARK, NJ 07066-1687
(732) 587-6740
(732) 587-6741
Mailing address
67 WALNUT AVE STE 307, CLARK, NJ 07066-1687
(732) 587-6740
(732) 587-6741
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
22DI00899900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22DI00899900
NJ DENTAL LICENSE
NJ
Enumeration date
05/27/2015
Last updated
05/27/2015
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