# KELLY B. MANSFIELD DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487813937
- **Authorized official:** DR. KELLY B MANSFIELD (OWNER)
- **Authorized official phone:** (208) 467-9271

## Contact information

- **Practice address:** 109 12TH AVE RD, NAMPA, ID 83686-5047
- **Practice address phone:** (208) 467-9271
- **Mailing address:** 109 12TH AVE RD, NAMPA, ID 83686-5047
- **Mailing address phone:** (208) 467-9271

## Taxonomy

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

## Other

- **Enumeration date:** 06/09/2008
- **Last updated:** 06/09/2008