Individual
LARA KELLOGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
3302 GASTON AVE, DALLAS, TX 75246-2013
(832) 492-6567
Mailing address
545 SEQUOIA ST, ALLEN, TX 75002-3363
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
34216
TX
Other
Enumeration date
07/12/2018
Last updated
01/27/2021
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