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Organization
GWENDOLYN KELLY DDS & ASSOC.
Active
Organization
GWENDOLYN KELLY DDS & ASSOC.
Active
Other names
GWENDOLYN KELLY DDS
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GWENDOLYN A KELLY DDS (OWNER)
(310) 412-9291
Entity
Organization
Contact information
Practice address
6230 W MANCHESTER AVE, LOS ANGELES, CA 90045-3801
(310) 412-9291
Mailing address
6230 W MANCHESTER AVE, LOS ANGELES, CA 90045-3801
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
29936
CA
1223E0200X
Endodontics
45472
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
20070
CA
Other
Enumeration date
05/09/2014
Last updated
05/09/2014
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