Individual
DR. KELLY CONNAUGHTON MANSOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
1650 N MAITLAND AVE, MAITLAND, FL 32751-3320
(407) 628-2286
(407) 629-2953
Mailing address
1650 N MAITLAND AVE, MAITLAND, FL 32751-3320
(074) 628-2286
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DN 18377
FL
1223P0221X
Pediatric Dentistry
Primary
DN18377
FL
Other
Enumeration date
07/06/2008
Last updated
10/04/2023
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