Individual
DR. KELLY HARRELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1405 CANNON PKWY, ROANOKE, TX 76262-3620
(918) 413-2774
Mailing address
3605 COUNTRY CLB, MOORE, OK 73160-7615
(918) 413-2774
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
34055
TX
122300000X
Dentist
7046
OK
Other
Enumeration date
06/10/2018
Last updated
06/10/2018
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