Individual
DR. JILLIAN K MCKELROY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1303 DR MARTIN L KING JR AVE, MOBILE, AL 36603-5341
(251) 432-4117
(251) 964-4012
Mailing address
PO BOX 2048, MOBILE, AL 36652-2048
(251) 432-4117
(251) 964-4012
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
5672
AL
1223G0001X
General Practice Dentistry
Primary
5672
AL
1223P0106X
Oral and Maxillofacial Pathology Dentistry
5672
AL
1223P0221X
Pediatric Dentistry
5672
AL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
5672
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5672
ALABAMA STATE LICENSE
AL
Enumeration date
07/14/2009
Last updated
07/30/2014
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