Organization
KELLY FAMILY DENTISTRY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTIAN H KELLY DDS (OWNER/DENTIST)
(812) 683-1112
Entity
Organization
Contact information
Practice address
1690 N MAIN STREET, HUNTINGBURG, IN 47542
(812) 683-1112
(888) 958-7816
Mailing address
1690 N MAIN STREET, HUNTINGBURG, IN 47542
(812) 683-1112
(888) 958-7816
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12011133A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200902290A
—
IN
Enumeration date
12/15/2011
Last updated
08/22/2018
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