Individual
KELLEY A. GYLLENHAAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
515 DELAWARE ST SE, 6-320, MINNEAPOLIS, MN 55455-0357
(612) 625-5110
Mailing address
1080 SHERMER RD, GLENVIEW, IL 60025-2730
(847) 404-5657
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
R578
MN
Other
Enumeration date
08/05/2013
Last updated
08/05/2013
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