# KELLOGG & KELLOGG PS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Tietan Dental Team
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912124637
- **Authorized official:** DR. DON R KELLOGG DDS (SECRETARY)
- **Authorized official phone:** (509) 522-0940

## Contact information

- **Practice address:** 1602 PENNY LN, WALLA WALLA, WA 99362-4477
- **Practice address phone:** (509) 522-0940
- **Practice address fax:** (509) 525-9063
- **Mailing address:** 1602 PENNY LN, WALLA WALLA, WA 99362-4477
- **Mailing address phone:** (509) 522-0940
- **Mailing address fax:** (509) 525-9063

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DE00004225 | WA | Yes |

## Other

- **Enumeration date:** 04/20/2007
- **Last updated:** 05/31/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5023346 | — | WA |