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1174018022
SAMUEL ROBERT KELLY
SALEM, OR
NPI
1174018022
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1223G0001X Dentist General Practice
(Licence: OR D10822)
Enumeration Date
2018-06-23
Last Update Date
2018-06-23
Business Address
SAMUEL ROBERT KELLY
3380 ASTORIA WAY NE
SALEM, OR 97305-1667
Phone number: 971-600-0211
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Mailing Address
SAMUEL ROBERT KELLY
3380 ASTORIA WAY NE
SALEM, OR 97305-1667
Phone number: 971-600-0211
Copy
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