Individual
MARK W KELSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
306 W 5TH AVE, NOME, AK 99762-0966
(907) 443-3311
(907) 443-3139
Mailing address
PO BOX 1308, NOME, AK 99762-1308
(907) 443-3309
(907) 443-3466
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
695
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
695
LICENSED DENTIST
AK
Enumeration date
10/20/2006
Last updated
07/08/2007
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