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1225481930
BENJAMIN KELLUM
POCATELLO, ID
NPI
1225481930
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
122300000X Dentist
(Licence: ID d4772)
Enumeration Date
2016-07-18
Last Update Date
2016-07-18
Business Address
Dr. BENJAMIN KELLUM DDS
IDAHO STATE UNIVERSITY
POCATELLO, ID 83209-0001
Phone number: 208-282-3289
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Mailing Address
Dr. BENJAMIN KELLUM DDS
IDAHO STATE UNIVERSITY
POCATELLO, ID 83209-0001
Phone number:
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