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Organization

MATTHEW J. KELLY, DDS, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MATTHEW KELLY (MANAGER)
(314) 249-1514
Entity
Organization

Contact information

Practice address
9 E VAN BUREN ST, MILLSTADT, IL 62260-2009
(314) 249-1514
Mailing address
9 E VAN BUREN ST, MILLSTADT, IL 62260-2009

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019030041
IL

Other

Enumeration date
10/24/2014
Last updated
10/24/2014
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