Individual
DR. KELLY MICHAEL CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2700 GRAND AVE, SUITE B, BILLINGS, MT 59102-2680
(406) 652-5550
(406) 652-0562
Mailing address
2700 GRAND AVE, SUITE B, BILLINGS, MT 59102-2680
(406) 652-5550
(406) 652-0562
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
1797-4
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0113815
—
MT
Enumeration date
09/13/2006
Last updated
07/08/2007
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