Individual
KELLY SOARES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
30 SAINT JAMES AVE, CHICOPEE, MA 01020-2453
(413) 592-2177
(413) 592-3278
Mailing address
19 TACOMA ST, WORCESTER, MA 01605-3516
(508) 852-1805
(508) 853-8593
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN19743
MA
1223G0001X
General Practice Dentistry
19743
MA
1223G0001X
General Practice Dentistry
DN1857981
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1301071
—
MA
Enumeration date
03/28/2006
Last updated
09/10/2018
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