Individual
KELLEY JESSICA QUOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
5150 N 16TH ST STE B147, PHOENIX, AZ 85016-3916
(602) 699-5983
Mailing address
5150 N 16TH ST STE B147, PHOENIX, AZ 85016-3916
(602) 699-5983
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
H06628
AZ
Other
Enumeration date
06/19/2018
Last updated
05/26/2021
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