Organization
SHAWN KELLY DDS INC
Active
Other names
Roseville Dental Group Sleep Solutions
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL SHAWN KELLY D.D.S. (OWNER)
(916) 773-1122
Entity
Organization
Contact information
Practice address
700 SUNRISE AVE, SUITE E, ROSEVILLE, CA 95661-4561
(916) 773-1122
(916) 773-3528
Mailing address
700 SUNRISE AVE, SUITE E, ROSEVILLE, CA 95661-4561
(916) 773-1122
(916) 773-3528
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
29984
CA
Other
Enumeration date
12/08/2016
Last updated
04/05/2017
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