Organization
TC ORTHODONTICS RED WING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHAD HOLLY KELLY D.M.D. (PRESIDENT)
(763) 420-1030
Entity
Organization
Contact information
Practice address
615 W 4TH ST, RED WING, MN 55066-2413
(651) 388-8851
Mailing address
615 W 4TH ST, RED WING, MN 55066-2413
(651) 388-8851
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
11493
MN
Other
Enumeration date
01/07/2013
Last updated
01/07/2013
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