Individual
DR. MICHAEL CHASE KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1655 S ENTERPRISE AVE, A-3, SPRINGFIELD, MO 65804-1850
(417) 881-1213
Mailing address
1655 S ENTERPRISE AVE, A-3, SPRINGFIELD, MO 65804-1850
(417) 881-1213
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2013017374
MO
Other
Enumeration date
06/18/2013
Last updated
06/18/2013
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