Organization
KELLY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL CHASE KELLY DDS (DENTIST)
(417) 881-1213
Entity
Organization
Contact information
Practice address
1655 S. ENTERPRISE AVE STE. A-3, SPRINGFIELD, MO 65804
(417) 881-1213
(417) 877-8156
Mailing address
1655 S ENTERPRISE AVE STE A3, SPRINGFIELD, MO 65804-1864
(417) 881-1213
(417) 877-8156
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
2013017374
MO
Other
Enumeration date
10/02/2013
Last updated
10/02/2013
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