# DR. ROBERT MILES KELSO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1487787172
- **Gender:** Man
- **Credential:** D.D.S.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 8033 | TN | Yes |

## Other

- **Enumeration date:** 03/13/2007
- **Last updated:** 04/20/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4062119 | BLUE CROSS BLUE SHIELD TN | TN |
| 01 | — | 450517441 | FEDERAL TAX ID | TN |