| NPI | 1194734335 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH R. KELLY President/Practioner 423-283-4175 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN DS2230) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2020-08-22 |