Organization
DENTALIGN P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD HOLLY KELLY D.M.D. (PRESIDENT)
(612) 701-0478
Entity
Organization
Contact information
Practice address
7860 MAIN ST, MAPLE GROVE, MN 55369
(763) 420-1030
Mailing address
4630 EDGEBROOK PL, EDINA, MN 55424
(612) 701-0478
(763) 450-5510
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D11493
MN
Other
Enumeration date
05/01/2012
Last updated
05/01/2012
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