Organization
WILLIAM M. KELLY, D.D.S., M.S., LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM M. KELLY D.D.S., M.S. (ORTHODONTIST/OWNER)
(630) 584-9666
Entity
Organization
Contact information
Practice address
11 S 6TH ST, ST CHARLES, IL 60174-2706
(630) 584-9666
(630) 584-9681
Mailing address
11 S 6TH ST, ST CHARLES, IL 60174-2706
(630) 584-9666
(630) 584-9681
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
019013853
IL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
019026074
IL
Other
Enumeration date
05/29/2009
Last updated
05/29/2009
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