Organization
JACOB D KELLY DDS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB DEAN KELLY DDS (OWNER DENTIST)
(916) 782-9479
Entity
Organization
Contact information
Practice address
2360 PROFESSIONAL DR STE 100, ROSEVILLE, CA 95661-7782
(916) 782-9479
(916) 782-3342
Mailing address
2360 PROFESSIONAL DR STE 100, ROSEVILLE, CA 95661-7782
(916) 782-9479
(916) 782-3342
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
07/01/2021
Last updated
07/01/2021
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