Individual
KELLY MANDELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
2722 COLBY AVE, SUITE 318, EVERETT, WA 98201-3557
(425) 551-1000
(425) 551-1001
Mailing address
2722 COLBY AVE, SUITE 318, EVERETT, WA 98201-3557
(425) 551-1000
(425) 551-1001
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH00007041
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5902481
—
WA
Enumeration date
08/05/2010
Last updated
08/05/2010
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