Individual
SHENIKA SHAREE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
514 E WOODROW WILSON AVE STE G, JACKSON, MS 39216
(769) 572-4425
(844) 270-0967
Mailing address
219 GREENFIELD RIDGE DR, BRANDON, MS 39042-7023
(601) 672-6085
(844) 270-0967
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
MS3644-12
MS
Other
Enumeration date
03/11/2012
Last updated
06/03/2018
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