Individual
DR. DANIEL MARTIN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
11 S 6TH ST, ST CHARLES, IL 60174-2706
(630) 584-9666
Mailing address
11 S 6TH ST, ST CHARLES, IL 60174-2706
(630) 584-9666
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
019026074
IL
Other
Enumeration date
09/06/2011
Last updated
09/06/2011
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