Individual
BRADLEY KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
6958 NEBRASKA AVE, FORT LEONARD WOOD, MO 65473-1618
(573) 596-0364
Mailing address
6958 NEBRASKA AVE, FORT LEONARD WOOD, MO 65473-1618
(573) 596-0364
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D-4583
ID
Other
Enumeration date
08/14/2014
Last updated
08/14/2014
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