Organization
KELLY BOSWORTH, DDS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KERIANN GERMAN (FINANCIAL COORDINATOR)
(952) 474-4123
Entity
Organization
Contact information
Practice address
6140 LAKE LINDEN DR, SUITE 230, EXCELSIOR, MN 55331-2954
(952) 474-4123
(952) 401-3482
Mailing address
6140 LAKE LINDEN DR, SUITE 230, EXCELSIOR, MN 55331-2954
(952) 474-4123
(952) 401-3482
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9311
MN
Other
Enumeration date
05/30/2008
Last updated
05/30/2008
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