Individual
DEREK RYAN KAELIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
540 W LASALLE ST, SPRINGFIELD, MO 65807-4712
(417) 887-1220
(417) 887-0357
Mailing address
2105 W. KEARNEY, SUITE A, SPRINGFIELD, MO 65803
(417) 862-2468
(417) 863-6775
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DEN 2003017125
MO
Other
Enumeration date
01/29/2007
Last updated
09/07/2011
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