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Individual

MRS. KELSEY DENISE MENEGOTTO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
DMD

Contact information

Practice address
777 BEACHWAY DR STE 202, INDIANAPOLIS, IN 46224-7877
(317) 297-1007
(317) 405-8694
Mailing address
10972 ALLISONVILLE RD STE 110, FISHERS, IN 46038-2639
(270) 314-6363
(317) 913-2360

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
9892
KY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12013532A
IN
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
9892
KY

Other

Enumeration date
03/12/2014
Last updated
06/22/2021
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