Individual
DR. KELLY ROSS CARLISLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, BS
Contact information
Practice address
535 E 500 S, BOUNTIFUL, UT 84010-3873
(801) 292-7807
Mailing address
391 W 3200 S, BOUNTIFUL, UT 84010
(408) 621-7744
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
11287528-9922
UT
Other
Enumeration date
01/28/2019
Last updated
04/09/2020
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