Individual
DR. KELLI JEAN BRUNK BLANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
607 W ORCHARD ST, VANDALIA, IL 62471-1234
(618) 283-2929
(618) 283-2113
Mailing address
607 W ORCHARD ST, VANDALIA, IL 62471-1234
(618) 283-2929
(618) 283-2113
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019028666
IL
Other
Enumeration date
06/20/2011
Last updated
08/17/2015
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