Individual
KELLY MARIE ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2920 S MCINTIRE DR, BLOOMINGTON, IN 47403-4221
(812) 323-8112
Mailing address
288 LOCUST DR, BLOOMFIELD, IN 47424-1026
(812) 545-5209
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
13008622A
IN
Other
Enumeration date
07/07/2021
Last updated
07/07/2021
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