Individual
KELLEY CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2141 S 63RD ST, OMAHA, NE 68106
(402) 551-1811
Mailing address
2141 S 63RD ST, OMAHA, NE 68106-2144
(402) 551-1811
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
61343
KS
122300000X
Dentist
Primary
7292
NE
122300000X
Dentist
RES-1326
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35-2382039
—
OK
Enumeration date
07/15/2016
Last updated
08/21/2019
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