Organization
TIMOTHY L KELLY DENTAL PROF. LLC
Active
Other names
Rushmore Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY LYNN KELLY DDS (OWNER)
(605) 593-0037
Entity
Organization
Contact information
Practice address
1600 MOUNTAIN VIEW RD STE 104, RAPID CITY, SD 57702-4354
(605) 593-0037
(605) 593-8351
Mailing address
1600 MOUNTAIN VIEW RD STE 104, RAPID CITY, SD 57702-4354
(605) 593-0037
(605) 593-8351
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D0505
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588653281
—
SD
Enumeration date
08/27/2016
Last updated
08/27/2016
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