Individual
DAVID KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2074 S 6TH ST, KLAMATH FALLS, OR 97601-3372
(541) 885-2011
Mailing address
2074 S 6TH ST, KLAMATH FALLS, OR 97601-3372
(541) 885-2011
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D10437
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
170061
—
OR
Enumeration date
08/11/2016
Last updated
08/11/2016
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