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NPI Code Detail

MEDICARE: DR. KATHLEEN KELLY KEY D.D.S.

MEDICARE: DR. KATHLEEN KELLY KEY 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 DentistryD10597MN

General Provider Information

NPI Number : 1992862601
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KATHLEEN KELLY KEY D.D.S.
Provider Business Mailing Address
First Line : 3938 CEDAR GROVE PKWY
Second Line :
City : EAGAN
State : MN
Zip : 55122-1403
Country : US
Telephone Number : 651-452-9660
Fax Number : 651-406-8544
Provider Business Practice Location Address
First Line : 3938 CEDAR GROVE PKWY
Second Line :
City : EAGAN
State : MN
Zip : 55122-1403
Country : US
Telephone Number : 651-452-9660
Fax Number : 651-406-8544
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2007
Last Update Date : 07/08/2007

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