Individual
AMBER L. KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
702 W KOENIG ST, GRAND ISLAND, NE 68801-6556
(308) 389-2811
Mailing address
702 W KOENIG ST, GRAND ISLAND, NE 68801-6556
(308) 389-2811
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6365
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100249671-00
—
NE
Enumeration date
10/19/2006
Last updated
07/08/2007
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