Individual
DR. MADELINE KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS, MS
Contact information
Practice address
1245 SE 3RD ST, BEND, OR 97702-2161
(541) 318-5688
Mailing address
1245 SE 3RD ST, BEND, OR 97702-2161
(541) 318-5688
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D11401
OR
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
07/04/2018
Last updated
06/04/2021
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