Individual
DR. KELLY MARIE SERVAIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1501 PARK AVE, COLUMBUS, WI 53925-1618
(920) 623-5559
Mailing address
1501 PARK AVE, PO BOX 500, COLUMBUS, WI 53925-1618
(920) 623-5559
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7088
WI
Other
Enumeration date
06/18/2013
Last updated
06/18/2013
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