Organization
PATRICK J KELLY DDS , P.C
Active
Other names
Fort Street Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHAWN M LAVOIE (INSURANCE BILLER)
31392885555
Entity
Organization
Contact information
Practice address
4009 FORT ST, LINCOLN PARK, MI 48146-4110
(313) 928-8555
(313) 928-1399
Mailing address
4009 FORT ST, LINCOLN PARK, MI 48146-4110
(313) 928-8555
(313) 928-1399
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901016290
MI
Other
Enumeration date
04/03/2012
Last updated
04/03/2012
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