Individual
KELLY LOY WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
617 W WATER ST, PRINCETON, WI 54968-9144
(920) 295-6350
Mailing address
169 MEMORIAL DR, BERLIN, WI 54923-1241
(920) 361-3080
(920) 361-3054
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
WI3155
WI
Other
Enumeration date
03/23/2007
Last updated
05/10/2022
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