Individual
DR. ROBERT MILES KELSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
6231 HIGHLAND PLACE WAY STE 202, KNOXVILLE, TN 37919-4083
(865) 588-6534
(865) 588-2576
Mailing address
6231 HIGHLAND PLACE WAY STE 202, KNOXVILLE, TN 37919-4083
(865) 588-6534
(865) 588-2576
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8033
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4062119
BLUE CROSS BLUE SHIELD TN
TN
01
—
450517441
FEDERAL TAX ID
TN
Enumeration date
03/13/2007
Last updated
04/20/2022
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