| Kelly Family Dentistry | |
|
514 E Woodrow Wilson Ave Ste G Jackson MS 39216-4538 | |
| (769) 572-4425 | |
| (844) 270-0967 |
| Full Name | Kelly Family Dentistry |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 514 E Woodrow Wilson Ave Ste G, Jackson, Mississippi |
| Authorized Official Name and Position | Shenika Kelly (DENTIST/OWNER) |
| Authorized Official Contact | 7695724425 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelly Family Dentistry 514 E Woodrow Wilson Ave Ste G Jackson MS 39216-4538 Ph: (769) 572-4425 | Kelly Family Dentistry 514 E Woodrow Wilson Ave Ste G Jackson MS 39216-4538 Ph: (769) 572-4425 |
| NPI Number | 1619338761 |
|---|---|
| Provider Enumeration Date | 03/17/2016 |
| Last Update Date | 03/17/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619338761 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 364412 (Mississippi) | Primary |
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