Individual
KELLY RAE DALLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
897 E IRON AVE, DOVER, OH 44622-2030
(330) 343-5555
(330) 364-8964
Mailing address
897 E IRON AVE, PO BOX 443, DOVER, OH 44622-2030
(330) 343-5555
(330) 364-8964
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1713
OH
Other
Enumeration date
03/01/2007
Last updated
07/08/2007
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