Individual
SAMUEL ROBERT KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3380 ASTORIA WAY NE, SALEM, OR 97305-1667
(971) 600-0211
Mailing address
3380 ASTORIA WAY NE, SALEM, OR 97305-1667
(971) 600-0211
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D10822
OR
Other
Enumeration date
06/23/2018
Last updated
06/23/2018
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