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NPI Code Detail

MEDICARE: DR. KELLY JOSEPH SEDARS D.D.S.

MEDICARE: DR. KELLY JOSEPH SEDARS D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry08219IA

General Provider Information

NPI Number : 1356428742
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLY JOSEPH SEDARS D.D.S.
Provider Business Mailing Address
First Line : 1126 GREENE ST
Second Line :
City : ADEL
State : IA
Zip : 50003-1712
Country : US
Telephone Number : 515-993-3701
Fax Number : 515-993-3701
Provider Business Practice Location Address
First Line : 1126 GREENE ST
Second Line :
City : ADEL
State : IA
Zip : 50003-1712
Country : US
Telephone Number : 515-993-3701
Fax Number : 515-993-3701
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 07/08/2007

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