Individual
DR. KELLY B. MANSFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
109 12TH AVE RD, NAMPA, ID 83686-5047
(208) 467-9271
(208) 466-3609
Mailing address
109 12TH AVE RD, NAMPA, ID 83686-5047
(208) 467-9271
(208) 466-3609
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-3113
ID
Other
Enumeration date
08/12/2006
Last updated
07/08/2007
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