| NPI | 1851675193 |
|---|---|
| Former Name | MICHELLE KELLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 8517) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS038725) |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2024-05-24 |