# MARSHALL DENTAL CARE, LLC

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

## Provider details

- **NPI number:** 1962918425
- **Authorized official:** DR. JERRY C KELLY DDS (MEMBER)
- **Authorized official phone:** (660) 886-6843

## Contact information

- **Practice address:** 263 S JEFFERSON AVE, MARSHALL, MO 65340-2134
- **Practice address phone:** (660) 886-6843
- **Practice address fax:** (660) 886-7855
- **Mailing address:** 263 S JEFFERSON AVE, MARSHALL, MO 65340-2134
- **Mailing address phone:** (660) 886-6843
- **Mailing address fax:** (660) 886-7855

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 12712 | MO | Yes |

## Other

- **Enumeration date:** 12/20/2017
- **Last updated:** 12/20/2017