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Individual
DR. ROBERT MILES KELSO
Active
Individual
DR. ROBERT MILES KELSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8033
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4062119
BLUE CROSS BLUE SHIELD TN
TN
01
—
450517441
FEDERAL TAX ID
TN
Enumeration date
03/13/2007
Last updated
04/20/2022
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