Individual
KELLI R LUCIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
6443 W 10TH ST STE 204, INDIANAPOLIS, IN 46214-6502
(317) 754-8486
Mailing address
7805 TIMBER RUN LN STE 100, INDIANAPOLIS, IN 46256-4734
(317) 213-3403
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
12009481
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100199300
—
IN
Enumeration date
11/21/2006
Last updated
07/05/2024
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