Individual
DR. KELLY LEIGH BUMGARNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2633 JEFFERSON STREET, SUITE 801, ALEXANDRIA, MN 56308
(320) 762-1717
Mailing address
2380 COUNTY ROAD 9 NE, NELSON, MN 56355-8167
(320) 491-4234
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D12536
MN
Other
Enumeration date
07/08/2008
Last updated
07/08/2008
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