Individual
MRS. KELLY ANNE MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD4
Contact information
Practice address
55 E LOOP RD, GROVE DENTAL ASSOC SUITE 201, WHEATON, IL 60187
(630) 653-8899
Mailing address
621 GLACIER TRAIL, ROSELLE, IL 60172
(630) 980-0992
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
—
IL
Other
Enumeration date
12/01/2006
Last updated
07/08/2007
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