Individual
HENRY PAUL KELLUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
985 AIRPORT RD, DESTIN, FL 32541-2835
(850) 837-6645
Mailing address
985 AIRPORT RD, DESTIN, FL 32541-2835
(850) 837-6645
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10931
FL
Other
Enumeration date
11/07/2006
Last updated
07/08/2007
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