Organization
KELLY FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHENIKA KELLY DMD (DENTIST/OWNER)
(769) 572-4425
Entity
Organization
Contact information
Practice address
514 E WOODROW WILSON AVE STE G, JACKSON, MS 39216-4538
(769) 572-4425
(844) 270-0967
Mailing address
514 E WOODROW WILSON AVE STE G, JACKSON, MS 39216-4538
(769) 572-4425
(844) 270-0967
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
364412
MS
Other
Enumeration date
03/17/2016
Last updated
03/17/2016
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