Individual
MATTHEW DIXON KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
112 SIXTH AVENUE, PAGE, AZ 86040-1956
(928) 645-3206
(928) 645-9139
Mailing address
PO BOX 1956, PAGE, AZ 86040-1956
(928) 645-3206
(928) 645-9139
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D008232
AZ
Other
Enumeration date
06/20/2011
Last updated
06/20/2011
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