Individual
MRS. SHASTA MARIE KELLERBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
195 W 14TH, RIFLE, CO 81650-4700
(970) 625-5200
Mailing address
2937 BROOK VIEW CT, GRAND JUNCTION, CO 81503-4808
(970) 260-6144
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
904683
CO
Other
Enumeration date
01/23/2012
Last updated
01/23/2012
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