| NPI | 1023168408 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRIS S KELLEY President 419-874-7071 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 17983) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2020-08-22 |