Individual
KELLY MICHELLE FENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS, MSD
Contact information
Practice address
64845 VAN DYKE RD, WASHINGTON, MI 48095-2836
(586) 752-3504
Mailing address
54557 JEFFERY DR, MACOMB, MI 48042-5815
(586) 419-2064
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2901600792
MI
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2901600792
MI
Other
Enumeration date
01/05/2021
Last updated
12/18/2024
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