Individual
DR. KATHLEEN A KELLY
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
44 E MIFFLIN ST, STE 204, MADISON, WI 53703-2895
(608) 256-0499
(608) 256-0577
Mailing address
44 E MIFFLIN ST, STE 204, MADISON, WI 53703-2895
(608) 256-0499
(608) 256-0577
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5001920-015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33374700
—
WI
Enumeration date
05/24/2005
Last updated
07/09/2007
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