Individual
DR. JERRY C. KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
263 S JEFFERSON AVE, MARSHALL, MO 65340-2134
(660) 886-6843
(660) 886-7855
Mailing address
263 S JEFFERSON AVE, MARSHALL, MO 65340-2134
(660) 886-6843
(660) 886-7855
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12712
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12712
STATE LICENSE
MO
Enumeration date
05/22/2007
Last updated
07/08/2007
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