| NPI | 1477997534 |
|---|---|
| Former Name | KELLY MCKENNA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD 15173) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN18778) |
| Enumeration Date | 2013-04-19 |
| Last Update Date | 2013-04-19 |