Individual
KELLY WARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 WEST COAST ROAD SUITE A, REDWAY, CA 95560
(707) 923-4313
(707) 923-2590
Mailing address
1173 ANGEL HEIGHTS DR, FORTUNA, CA 95540-1530
(707) 407-8071
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
29096
CA
Other
Enumeration date
01/19/2017
Last updated
01/19/2017
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