Organization
KELLY B. MANSFIELD DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY B MANSFIELD (OWNER)
(208) 467-9271
Entity
Organization
Contact information
Practice address
109 12TH AVE RD, NAMPA, ID 83686-5047
(208) 467-9271
Mailing address
109 12TH AVE RD, NAMPA, ID 83686-5047
(208) 467-9271
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/09/2008
Last updated
06/09/2008
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