Organization
DENTAL CORPORATION OF KELLY A. ELWARD, DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY ANN ELWARD D.D.S. (PRESIDENT)
(707) 539-4646
Entity
Organization
Contact information
Practice address
1820 SONOMA AVE STE 100, SANTA ROSA, CA 95405-6617
(707) 539-4646
(707) 539-3617
Mailing address
1820 SONOMA AVE STE 100, SANTA ROSA, CA 95405-6617
(707) 539-4646
(707) 539-3617
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
42914
CA
Other
Enumeration date
12/28/2012
Last updated
12/28/2012
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