| NPI | 1831614627 |
|---|---|
| Other Name | MICHELLE KELLY DDS |
| Entity Type | Organization |
| Authorized Contact | MICHELLE J KELLY Owner/President 262-646-4188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2017-08-14 |
| Last Update Date | 2022-07-21 |