Healthcare Provider Details

I. General information

NPI: 1134961485
Provider Name (Legal Business Name): KELSEY PENCE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2024
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14932 LIMA RD
HUNTERTOWN IN
46748-9275
US

IV. Provider business mailing address

14932 LIMA RD
HUNTERTOWN IN
46748-9275
US

V. Phone/Fax

Practice location:
  • Phone: 260-637-5848
  • Fax:
Mailing address:
  • Phone: 260-637-4858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12014788A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: