| NPI | 1811542640 |
|---|---|
| Former Legal Business Name | KELLY HENRICHS DDS |
| Entity Type | Organization |
| Authorized Contact | KELLY HENRICHS Owner 620-225-6555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2019-08-08 |