Organization
KELLY E. CARLEN, DDS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY EDWARD CARLEN DDS (OWNER)
(208) 461-1060
Entity
Organization
Contact information
Practice address
2811 12TH AVE RD, NAMPA, ID 83686-8482
(208) 461-1060
(208) 465-6303
Mailing address
2811 12TH AVE RD, NAMPA, ID 83686-8482
(208) 461-1060
(208) 465-6303
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D3271
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8061407
—
ID
Enumeration date
04/23/2008
Last updated
04/23/2008
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